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FOR OFFICE USE: F FOR OFFICE USE: T APPLICATION FOR SANITATION PERMIT --------------------------------- ----------------------- Permit No...77� r$6 , ° (Complete in Triplicate) _ =:---- Date Issued...7�---- f --------------- TWs 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: , _ ._._ CENSUS TRACT----------------------------- ------------------------------- ' JOB ADDRESS/LO TIO :_------ -- J .� 1 t ----Phone _-----------Owner's Ni :► s / f--- --------Zi Address- �// `..`'------------------------- L144 --------------------- " .-. /ff� ��`�►— = City/w, `�s'�"`r P � ' . - - .� q L Contractor s home____ _____ ____ - ----_._License #- --/ >3-/-_--Phone__�G y-� �� ---- - Installation will serve Residence ❑ Apartment House 0 Commercial ®' -Trailer Court ❑ :. Motel.❑ ... Other - --- -- F. k' '- r- � M Number . Yr of living units___ ________ ____Number of bedrooms--------------Garbage Grinder _ =_Lot,.Size_ _-_ "_- - Water Supply: Public System and.nome . ------ - _ # -; �� :- i -- -------- f --------_ -_Private Character of soil to a depth of 3 feet: Sand ❑ Silt❑ Clay ❑ Peat ❑ Sandy Loam ❑ Clay Loam ❑ . . .< .. Hardpan El . Adobe Fill Material_- ---- If yes, type_____________________________ a (Plot.,plan, showing size bf 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 available within 200•feet,) i PACKAGE TREATMENT ( ] ; SEPTIC TANK [;]' Size ='- _= Liquid:Depth. '-- ---------------- i =T e =° Material --------------------.. No Com~brtments------ -------------------------- Capacity -------------=: Type p - T - F ----- --- - 'Foundation--, Total Len-..Prop. Line--------=- . --------------- Distance to nearest:.Well__________ ___g_--_:____.._ � - Length of each-... ! - th ---------------= - LEACHING LINE„ [ ]. No. of Lines--------------= - ---- --- * .h_line.-._, "=-----------r g 'D' Box --------Type Filter Material'___ _,Deptk Filfer Material-------------------------------------------------------------- T _-.-.--_ -__-- ' _-----_ __.___ --- i - -- i K Property Line_ F f i: SEEPAGE PIT [ ] Depth----___---------Diameter_____.-- ---,- f Number__=------ __ � ) Distance�.to nearest: Well_'._.____ � Foundation . '-- i Rock Filled 'Yes ❑ No ❑ : ------------------- Water Table Depth--- ------ - --- -------------.-----------Rock .Size -------------= ! �_ ---------------------------- Foundation ------- Prop. Line. ' REPAIR ADDITION (Prev:Sanitation Permit#--:- ._-_-- 1 Distance,to nearest; Well_..______ / --._ Date- -------- � ----------------- ---------) Septic Tank (Specify Requirements)------- =-- ' = - = ---------- Disposal Field (Specify Requ.irements)'_ --- --1---- :--- -----� ' = '` ------------------------ --------------------- - --- - ----------- F ----- 1 -- ------------------=----------------------------------- ---------- - - ----------------- t. Draw existin "and required" ( g q additiononreverse 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 v_. signature certifies the following: rt. - "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 beco :s Me to kman' Compensation laws of California:'.' . Signed_ = n - f i _ / > W er By--------------- / �' - ' •-r--' Title= - ; if oche owner) too ± - FOR DEPARTMENT USE ONLY. ^_ APPLICATION ACCEPTED BY r-- * r ---- -----=- DATE. - ------ DIVISION OF LAND NUMBER--------. -------------------------- DATE------- ---------- ---------------------- -`----- E ADDITIONALCOMMENTS---- ------- -- ------ ----------- ------------------------------- -------------------_ -- ---------------------- ------------------------ -------------- ------------ # ------------ --------------------- -- -------- _ ----------------------------- ---1-_----------- ----- - Date.Final-Inspection by:- ---------- ----- - --. EH 13 24 SAN JOAQU LOCAL HEALTH DISTRICT_y F&S 21b77 REV. 7/76 3M