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FOR OFFICE USE: FOR OFFICE USE.. 1 �{ �d APPLICATION FOR SANITATION PERMIT --------------------- ..... .. .... ------- Permit No..7..1'.:-_�.,p (Complete in Triplicate} ----------------------------------------------------- Date Issued-7-` ... ......................................................... This Permit Expires 1 Year From Date Issued I Application is hereby made to.the San Joaquin Local Health District for a permit to construct and install the work herein described. w This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: i : .CENSUS TRACT...............JOB ADDRESS/LOC N �/!....--A e�/Owner's Name...... � �7 ........ Address - ' -fir'. ...... - - City-- - Zip .-.. ... p-- C' Contractor's Name.... C€�,� ...- ' License ..Phonj f Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court Motel ❑ Other.... ------------ ---------- Number of livingunits: '..Number of bedroom Garbo e GrinderNO..."Lot Size..... ...... ....... g = ........ - J Water Supply: Public System and name. ICS- -C e-J �_�1 ------ - ----- ---- Private ❑ Character of soil to a depth of 3 feet: Sand ❑ Silt ❑ Clay Peat ❑ Sandy Loam ❑ Clay Loam ❑ Hardpan ❑ • Adobe ❑ Fill Moteria ... if yes, type----------------------- -- (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 available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK [ ] Size ------ ----------------------------------------------- -Liquid Depth.---- ......------.------ Capacity....... .............Type----------------- ...Material .................------.:No. Compartments------..------------------ -------- Distance to nearest: Well..................... ._.._.... ......---Foundation......... ... ....-.Prop. Line-----.-----.----- ------- LEACHING LINE [ ] No. of Lines ----.........................Length of each line..-------------------.........Total Length --- -------......----.-----..---.---.-- 'D' Box---- ....Type Filter Material_............ .....Depth Filter Material--.-------------------------------------.--------------........ Distance to nearest: Well..--------.- .--.._.Foundalion ------------------------Property Line--------- --------_---"--.c. SEEPAGE PIT X . Depth. -----Diameter-: i1." ....Number_.__ -.� -.""...._.. ft Rock Filled Yes�, No ,rte Water Table Depth ................ Rock Size/751... . py Distance to nearest: Well.AIWV ---------------------- ""Foundation_../0........ Line.... --------------- REPAIR/ADDITION (Prev. Sanitation Permit#------------ .................... ----------Date------------_-----------.....- -------..-----} Septic Tank (Specify Requirements]... +- Disposal Field (Specify Requnts).c�- ir - - --=-------- --- -----• ---------------- - ..... ... ....... ......... ------------------ ------------ ------------------------- ---- -------------------.. (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 erformance of the work for which this permit is issued, I shall not employ any person in such manner as to become sub ct to Workman's Compens ton lawss off CCalifornia." Signed............. .. ' =�� Owner B /.�_ Title.--- . •. (If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED Bl_ . . �---- ......_.... DATE ^`..3-.` ... DIVISION OF LAND NUMBER.._ ......... ........ -- ]TATE.-- .-_--------- ---------- ...... ADDITIONAL COMMENTS...C& . " # -------------------------------------------- / ---_---_ -----------------•--------- ----------------------..-..--------------------------- -- --- ----_ ...--.......... ---. I ------ ---------------- ----- - 71 e. :Final Inspection by:. -Date------ --- -------- ---- ---------•-•------- I EH 13 24 SAN JOAQUIN LOCAL HEALTH DISTRICT. Fas 21677 Rev. 7176 3M r