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: �'� FOR OFFICE USE: <br /> FOR OFFICE USE <br /> APPLICATION FOR SANITATION PERMIT 7-2^ � <br /> ---- ------- ---------------- ------------ - p p Permit No. -------- S3 <br /> (Complete in Triplicate) <br /> e � 77 <br /> a .Date Issued__..-.-'._____. <br /> This Permit Expires 1 Year From°-Date Issued, <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and,install the work herein described. <br /> This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations. <br /> ..._CENSUS--------- SUS TRACT------=------- ------ ---�--- <br /> JOB ADDRESS/LOCATION-__ .Y�:T.-."i'-�------ -- -"- � - - - - <br /> Owner's Name ------ � Phone---- <br /> ------------------- <br /> Address---------- ------- �7 <br /> --City- Zip <br /> ; - <br /> ense # ��/ � Phone <br /> Contractor's Name tic - <br /> � e-- <br /> -s-i <br /> Installation will serve: � Residence`❑^^"`Apartment-House-:0--•-•Comrrierciai-❑ Trailer Court ❑ <br /> Motel ❑ Other--------------- ---- ---:----------------=---'- <br /> Number of living units:------l----------Number of bedrooms__.._ Garbage Grinder_..---------Lot Size.---- ------------ <br /> Water Supply: Public System and n time .- -- -------- ----------------------- '`—W ----- ---- -- --------- ---------------------Private <br /> t r of soil to a depth of 3 feet: Sand Silt El Clay:• ;Beat,© . 'Sandy Loam Q Clay Loam a <br /> Charac a Hardpans❑ ' Adobe El Fill Material.-.-____---.If yes, type-.-- -------- <br /> \ � <br /> - 1 <br /> (Plot plan, showing size of lot, Qation of system in relation to wells, buildings, etc. must be placed on reverse side.) <br /> NEW INSTALLATION:' {No�`'septic tank or seepage .pit permitted if public sewer is availaE�le within 200 feet,) <br /> I - —..-Size. . �_ - Q-.�- _ -----------Liquid Depth <br /> K [ l y - <br /> PA l<AGE TREATMENT Ca ac ET1C-�' No. Compartments-------- - -- ---------_______ <br /> M• <br /> i <br /> p TYPe aterial -'l <br /> 4 '.J <br /> • - -,`Distarnce to neo,est: Well.- --- -- ------------Foundation--------------------------Prop. Line---------------------------c t <br /> Length of each lin®. Tofial Length. 7 -------------- - <br /> LEACHING LINE ['] No, of Lines-'., ------------- $ <br /> t 'D' Box------/ -.-Type Filet! Material- �.Foun <br /> Depth Filter Material 1--------------------------- V <br /> -D CJ <br /> ,Distance to nearest: W dation-----------------------------Property Line------------------- ----------- --- <br /> SEEPAGE PIT [ � Depth__ --tj .--D#ameter-..3_ .-----.---_Number-___--' -------_-_:----- ock Filled Yes No ❑ <br /> Water Table Depth---------- ------------ Size ``- ---------------------- -� <br /> t - <br /> -"'Distance.to nearest: Well.__ Foundation.-_- _ -. - - Prop, Line- -- -------- -------!_-. <br /> .1 l , r <br /> REPAIR/ADbITION (Prev,Sanitation Permit#--------------------------------- -------==-------Date.- ----------------- - .------ -- 1 <br /> - ---------- -- -- --- ------ <br /> Disposal <br /> -- <br /> Septic Tank (Specify Requirements)- --------- --- -- - - ----------------= ----------------- ------------ � #- <br /> p { p Y q rementsl------ ------ ---- - -- -- --------------------------------------- ---------------- --------------------------- ------- `. <br /> Dis osal Field. 5 ecif Rel ui ------------- ---- <br /> ---------- ------ <br /> 1 '. <br /> = .:. ; <br /> ----------------------------------- <br /> .. . _.. --------------- --- -- 1 <br /> ----------------- <br /> (Draw existing and required addition on reverse side] <br /> I hereby certify that I have prepared this#application and that the work will be done in accordance with San Joaquin County <br /> Ordinances, State Laws, and Rules and Regulations of the San Joaquin�Local Health District. Home owner or licensed agents <br /> signature certifies the following: <br /> I ~� <br /> "I certify that-in the performance of the.,workA6r whicFi this.permit_is..issuedJ 1 shall not employ any person in such manner as <br /> to become subject to Workman's Compensation laws of'-California." <br /> ! ! ------•Owner <br /> - <br /> Signed--- --- <br /> # . -. - ti- � ----- ----- Title --- ------ ------- --------• <br /> ---- <br /> By-= <br /> (If' other han iowner)' 4 <br /> � FOR.DEP MENT USE ONLY <br /> DATE.- <br /> APPLICATION ACCEPTED:BY ------------- �� '� ----------- <br /> D1VISION OF LAND NUMBER:_.. 1 DATE ° <br /> ADDITIONAL COMMENTS.-' - - ` <br /> fl- --------------------------- <br /> --------------------------- - - f --- <br /> ------------ ------------- ------ <br /> = j- fi <br /> ------------ ---------- � <br /> -- ---- ------------ ----------------- - - ---- - <br /> ------ <br /> ---- -- ----- -- ------- <br /> Dat <br /> Final Inspection by:=:- --- ---------- <br /> - -- ---- <br /> .---Da e._ -- <br /> EH is 24 SAN JOAQUIN_LOCAL HEALTH DISTRICT F&5 21677 REV. 7/76 Im <br /> :4 . .' <br />