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F R OFFICE USE: - 7.,��-_ APPLICATION FOR SANITATION PERMIT FOR OFFICE USE: (Complete in Triplicate) Permit No....7 �:..-�p ......................... ---...-..-, - ..- .... - �- This Permit Expires 1 Year From Date Issued Date Issued--- 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 made in complionce with County Ordinance 549 and existing Rules and Regulations: JOB ADD,KESS/LOCATION.-...... +lTCENSUS TRACT..__... ; ---- --------..--••----•--- - a Owner's Name.- . . Phone .l7�....................a Address..----..... �^/!, -•--- �.d-7 ....- Cit - ------------ ---------•-- ----- .- Y- -- .Z ZZ Contractor's Name..:...- ..--- � - - p----...�------- -------- ------ - ------ - .....License Phone.? Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ rN't Motel ❑ Other---------- --- 1 - - ------ . ------. umber of living units:. _ -Number of bedrooms.... ...Garbage Grinder--------. .Lot pPv= S Size Water Supply: Public stem and name.....:............. System Sand - -- -------------- --�- ---•-�r-• - ......--- -....--•----- ... - - - -- ---- •-------------- Private Character of soil to a depth of 3 feet: .Sand ❑ Silt E] Clay ❑ Peat❑ ❑ Hardpan ❑. :.;adobe Fill Material.. Sandy Loam E] Clay Loam....If yes, type------------------.. ........... (Plot plan, showing size of lot, location'of system it relation to wells, buildings, etc, must be placed on reverse side.[ :NEW INSTALLATION; (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) 4� PACKAGE TREATMENT 1 1 o. q ' [ 1 SEPTIC TANK [ Si e._'7� S :F ... -------Liquid Depth._.------- Capacity-./.a.�Q-..._..TYPe.-- 'er --- ..... __-No.MateNial.-/. No. Compartments...._._.:~. Distance to nearest: Well.......aha..--- __ .. r Foundation----a-d Prop..Line LEACHING LINE / ---.Length of each .......line....L/Q-- ---- [y' No. of Lines..._... (=_.. Total Length -.....�Q 'D' Box. --..:_....Type Filter Materia;ls'1 .Depth Filter Material..../G�p.--.#---,- r Distance•to nearest: WeIL..,,?'" t fi r Foundation�Q. --------- Property Lines - [ -------------- Depth./d." D+a�laetexr . ADZ- ------Number--------�--------- -- --------- - - „�,...w�,Rock._FiII-edr:Y.e No ❑ Water Table Depth......... /-C"_ ----- ----- Rock Size..-- C? . Distance to nearest: WeIL....:-.tom- -- -- // r .Foundation s� ... ....Prop.,Line-- - i REPAIR/ADDITION (Prev. Sanitation Permit#' _:-------------------- ---- - ---- -- - .........'Date---------........ -- - ) - Septic,Tank (Specify Requirements). -------- ------- Disposal Field (Specify Requirements)._._.---------- ---- -- ---.. .._...--:.. -- -•--------- -- - (Draw existing and required addition on reverse•side) I 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 sWo an's Com pensafion laws of California." z Signed-------- lut ' caner ;Z By.................. :..Title (If other than owner - ': YOR DE A ENT USE ONLY APPLICATION ACCEPTED BY----- �. -.-. . ...L1c — BATE ... ------ -------------------- DIVISION OF LAND NUMBER .. ..... .... ... .. DATE-.--.-.-----.-----..._---.-_.-, s ADDITIONAL COMMENTS..' -- ..---- ._- --~ ------- ......................... ........... i sp------------------by: ... ......... .............-.....----------------------•- --------.....-- ------------------- -------------------- - -- Final Inspedlon b ��nn - f . YC "- ------ - --------- --------------------- --------- --------------- •--....- -----..-..Date----- -- :!{ 13 24 , SAN JOAQUIN LOCAL HEALTH DISTRICT F8Z 77 0.EV 7 76 3M C