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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT -77 Permit No. 7_�'�--�.--- ------- ----- ----------- (Complete in Triplicate) ---------=--------- ------------------------------------- Date Issued ------------------------ This Permit Expires 1 Year From 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 compliance with County Ordinance No. 549 and existing Rules and Regulations. JOB ADDRESS/LOCATION .__�7_fi�-01`--_---6� � _e'----- P�---------------------- CENSUS TRACT ------ ----- --- l D V' ------------------------------------------- Phone ' �( � Owner's Name - - --- -------- - -------�----- - Address - - CP 6,�- �z._ Cit ! _ IH C��y = G� 1�-------------- Y - f � ! ---.License _c _Z _____ Phone _ � _ � Contractor's Name -. �--._�fQ:1� �/'�P- --------- ----------- ---- i�� installation will serve: Residence ❑ Apartment Nouse❑ Commercial Trailer Court 'El Motel ❑ Other ------------------------------------------ Number of living units:---I------- Number of bedrooms __:;;��arbage Grinder --- -------- Lot Size ------------ Water -------Water Supply: Public System and name ------------------- --- -- -----------------------------------------.Private Character of soil to a depth of 3 feet: Sand Silt❑ Clay ❑ Peat ❑ Sandy Loam •❑ Clay Loam ❑ Hardpan ❑ Adobe-C7 Fill Material ------------ if yes,type ____________________________ (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) V� NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) `' PACKAGE TREATMENT [ ] SEPTIC TANK'[ ] Size_____ -__s y` - --"C- ----- Liquid Depth _-_ ____ ----------- O '�— Material_@ ,'1 0. Compartments ---------------- ---- Capacity -------- --------- Type `"''�i . _Foundation ------�-0--/---=-Pra Line __-c'�?--------------- Qistance to nearest: Wel! -------6_6_1 - p• LEACHING LINE [ ] No. of Lines ------f--------------- Length of each line------ ------------ Total Length -l.__-- ------------- 'D' Box ------------ Type Filter Material __ !_C___+�__Depth Filter Material ------------------------_- i �' f --------- Foundation ----/_ -- Property Line. -- --- -------------- Distance to nearest: Well - .�1---._- M SEEPAGE PIT [ ] Depth ------->------------ Diameter ---------------- Number ._-------- --- Rock Filled Yes ❑ No ❑ l�Water Table Depth ------------------------------------------------Rock Size --------- -------------•-------- Distance to nearest: Well ----------------------------------------Foundation -------------------- Prop. Line _._-----.-----------•. REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date ----------------------------------) Septic Tank (Specify Requirements) __________________ __ --------------•------••--- -------------------------- Disposal Field (Specify Requirements) ---------------- ---------- ---- -------------- ------------- ---------------------------w--------------------------------------------------------------------- ------- -------------------------------------------------------------------------------------- (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 licen- sed agents signature certifies the following: I I employ any person in such manner "I certify that in the performance of the work for which this permit is issued, I shall no as to become subject to Workman's Compensation laws of California." Signed -- ------ - ----- -------------------- --- -- Owner -- --- ----- - - -------- Title ----------------- - ------- ------------------------- - ----------- (If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY -__. ---` ------- ----------------------------------------- DATE --- -�a. - _--------- BUILDINGPERMIT ISSUED ----------------------------- --------------------------DATE ------------------------------------------- ADDITIONAL COMMENTS ---------------------------- - ------ ---------- ---------------------- --------------------------------------------------------------- ----------------------------------------------------------------------------------------------------- - - ------------------------------------------------------------- - ----- - _. - --- __ -- ---- - - - - / Final Inspection by-.------ y: _ ---- ----------- ------------ ------------------------------------ --- Date SAN JOAQUIN LOCAL HEALTH DISTRICT r_ u n , .cQ Ve AAA