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FOR OFFICE USE: �P FOR OFFICE USE: ' APPLICATION FOR SANITATION PERMIT (Complete in Triplicate) Permit No„7$-.1D ---. ------- -•--------.... %� Date Issued-j/---- `� ..................................... ................... 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 rdinance No. 549 and exist' g Rules and Regulations: JOB ADDRESS/LOCATION....--. �� g� CENSUS TRACT.------_----------- ---------- ...... 1 ------------- -- d Owner's Name... ......... --- -- -- ...{ -. Phone........ ------------------- ---- 'Address ---- �Q �d f --.city.- . . - Zi P---:---..-:-�-_- .. .--- -- ..-- . License # C Contractor's Name...... " 27Y - Phone.. Installation will serve: Residence ❑ Apartment House ❑ Commercial Trail r Court ❑ j, Y t1 a Motel Other------------ --------- ------- Number of living units:................Number of kiedroams.....- - Garbage Grindea..----------Lot ize.--....., c..#.74 ----.-.....-..... - -- Water Supply: Public System and name....... ................ ------•------••--------............-...------------------- Priva Character of soil to a depth of 3 feet: : Sand ❑ Silt❑ Clay ❑ Peat ❑ Sandy Loam ❑ . Clay Loam ❑ �! Hardpan ❑ " 'Adobe V Fill Material._ ----If yes, type............ ........ (Plot plan, showing size of lot, iocation`of system in relation to wells, buildings, etc. must be placed on reverse side.) NEW INSTAL;ATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) f i / QPACKAGE TREATMENT SEPTIC TANK Size ---- -- Liquid DePth.. Ca acct Material No. Compartments .---- ----- _---.--.--`�' T_ P Y_M&)- -- -•.Type 'Gl -r- Foundation-..- M Distance-to nearest: Well--------- -.- - -- ... ......Prop. Line-.... ......-.....- d LEACHING LINE No. of Lines ....../.................Length o ch line.�Q� ...--Total Length .. ._., .- -. .-.-_..-:. - . 'D' Sox..........--Type Filter Material. Depth Filter Material-.-------/------- ----------------------- ---------- Distance to nearest: Well..-- ...............Foundation-. ------------ Property Line.............----------.----------•. SEEPAGE PIT [ ] Depth-- :-..Diameter-----------------_Number..-.--..---------- ------ Rock Filled Yes ❑ No Water Table Depth--------------------------------------- ------------Rock Size.----.... .......... rt:--•`� Distance to nearest: Well---------•-- ----.------Foundation----.___................ Prop. Line......... ..._____-....- REPAIR/ADDITION (Prev. Sanitation Permit#---------------------------- -- ...........Date........-.....-------_-----------.----------1 SepticTank (Specify Requirements).... ...... ---- ..--...-•------------------ ---- ---------------------------------------------- --------------------------------------- ----..., , Disposal Field (Specify Requirements)':................. . . ----------------------------- ---------. f. .a Y ....................................................................... .:(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 craws, and Rules sand Regulations of the San Joaquin Local Health District, Home owner or licensed agents signature certifies the following: i "Icertify tha in the performance of"the work for which this permit is issued, 1 shall not employ any person in such manner as Signed-_..*bc .. ._..QQ ...;,u ----------- --- - --- O to bec meo W r mn s Com ensation lows of California." :.-..-.--Owner BYE ' Title.----- f (If ot1 er than owner) FOR DEPARTMENT USE ONLY pa APPLICATION ACCEPTED BY.......... . ---.... .DATE DIVISION OF LAND NUMBER...-.-.-.............. ...............................DATE .-------------- ---------- -- ........ ADDITIONALCOMMENTS..-- .......:....-... . ---------------------------------------------------------- ------ -- ------ ---- -------------- - ....... ------------ ------ -------------------------------------------------------- Final Inspection b ----Date._.1-�/ --.�. . ......... -- EH 13 24 SAN JOAQUIN LOCAL HEALTH DISTRICT fas 21677 REV. 7176 3M