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FOR OFFICE USE: FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ------------------------ (Complete in Triplicate) Permit - - 7 Date Issued,-C-----)-,C------ ----------------- ------•---------- ---------- This Permit Expires 1 Year From Date Issu"ed---"s, o I Application is hereby. made to the San Joaquin Local Health District for a permit to construct and install the work Herein described. This application is mcide in compliance with County Ordinanc No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION -- - ---------- --- ------------ ! C US TRACT e i= ---- ---------------------- -------- - . --- - - Owner's Name----- .._ -_---------------. hone Address_4r ---_-`'�-� --- Ci 1 = ._1 ---- -- --------------- Contractor;s Name - -- ----- ---' - , ----- �l License 317 Phone--------------- G/c Installation will iserve: _ EE� Residence . Apartment House.❑ Commercial ❑ Trailer Court ❑ Motel ❑ Ot ;hE er----------=` -----"- --�---`--...- ------ -=: - ` Number.of living units: .__i.f-� 4U ' erof.bedrooms. T ___Garbage Grinder_....--..-__Lot Size __ ._ _ Water Supply: P blit System�and�name :: --- - ------ -- ...... ----- =-' Private' at ... ... t M Character of soil-to a depth of 3 feet: Sand ❑ Silt❑ Clay ❑ - Peat ❑ ) Sandy Loam Clay Loam ❑ -- - - --- ---F— -- Y Hardpan ❑ Adobe ❑ Fill Material_- ---------If yes,`type--------------------------------- (plot ____________ - t , (Plot plan, showing size of lot, location of system in relation to.wells, buildings, etc. must be placed on reverse side.)' NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is avaifnble within 200'feet,) �µ PACKAGE TREATMENT [ ] SEPTIC TANK [ ] Size_-- ' - -------=------ _-------_---Liquid Depth ---------------- ,. - i -- Gap�ay'city __:_ -=Ty pe _ = Material------=== ---.--.No..Compartments----------------------------- Distance to nearest: Well------------------- � _____._.___Foundation :=_- ----- .. . != Prop..Line LEACHING LINE;_.f ) Da Box. - =7 e Filter Matereangtho f each_line Depth Filter--- ;,._,__.Total Length.!------------------ ____._.____---- 1M --Type � P Material .-- ----- Distance to nearest: Well__ --__._ ._ 'I 1.r .Foundation_ _________ _______ _Property Line _ SEEPAGE PITDepth----------- ---Diameter------.-----:'--�'Number_ ,=l---------------------__ Rock Filled Yes ❑ No Lt R Dista ce to �eare``st: Well ----------. �--�----'------ ------ L p` �.Rock Size-�------------------ --------------- - --- Water Table'be th----.-------------- - ----------------------= --- - Foundation - Prop. Line --------------------------. 1 REPAIR/ADDITION (Prev. Sanitation Perm it#____.___ __A_ ____________________ - - - -------------- Septic Tank (Specify Requirements)_ __: = ' ' '----- --------= = j =_ --------------------------------------------------------------•---_----- (.fi�N 4�d- Disposal Field (Specify Requirements)___________________r.-_ _� ------- -� - r _______________________------------------------_______--------------- -------------------_____________________________'------------------------------------------------------------------------------------------------ (Draw existing dnd required addition-on reverse side) ' hereby certify that I have prepared this.application and that the -work will be done in accordance with San Joaquin County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner or licensed agents signature certifies the following: "I certify that in'the performance of'the work for which this permit is issued, I shall not employ any person in such manner as to become ject to . man,'s Compensation laws of California." 5igned 1 -- - BY --L�.� - - - ------ Title .A,/, ---------------- (If lbWe than owne t FOR DEPARTMENT SEO } APPLICATION ACCEPTED BY_�IM________________ .__ DATE __.. __ ------------ ___________ DIVISION OF LAND NUMBER.IM_____________ ' - -�__ ----DATE---------------- ------------------------- ADDITIONAL COMMENTS --------- ------------------------------------ ------ -=--------------=- - J , - ------- -------- -- �� - - ---------------------------- -- ------- -------- ---------------------- ------------------ - ------------------------------------------ - ---------------------- ------------------- - Final Inspection b - - �N_ --�. . _ p Y ----- - - ------ --------- .. -- --- / 1�. =-Date._ �2' � ''--- EH 13 2A SAN JOAQUIN LOCAL HEALTH D ICT F&S 21677 REV, 7/76 3M s