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FOR OFFICE USE: FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT 7 7— --------------------------------------------- (Complete in Triplicate) Permit No... ------------ ------ -------------------- --------------------------- Date lssued_.//:�_._._-Z2 -----------------------------------------------_----- .-" This Permit Expires I 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: -_�- � ._ . /Ua-e-1 N-4 -----------------I-------------- JOB ADDRESS/LOCATION_-_._..__� -- . . _ _ __ .CENSUS TRACT_---------------........... Owner's Name------------ OeA_/U...T). )-------------------------------------------- ----------------------------- ---Phone a Address ' -- - --------------- ---- CitYA / G ziP `�` ` Contractor's Name---- /4�_ .,..1CJ _ _t�..i --------- ----- ---4-------- t ---- --•- -----License #-��---�� Phone - i � 9- -- -- ---r�-------- Installation will serve: Residence tg Apdrtment House.❑ Commercial ❑ Trailer Court ❑ r Motel ❑ Other-:---------------------- -- --- --- -------- ----------- ------ G Number of living units____ ____________Number of bedrooms,__----Garbage Grinder'_.__________Lot Size-_____ __..__,.___.- ________._____ Water Supply: Public System and name----- --}--- - --------- `' z ----------Private ]� Character of soil to a depth of 3 feet: Sand ❑ Silt❑ Clay ❑ Peat ❑I Sandy Loam Clay Loam ❑ Hardpan ❑ Ad,obe,❑ 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.) NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,} PACKAGE: TREATMENT [ ] SEPTIC TANK j ] Size---------------------I------------- -------------Liquid Depth.------------------"------- r Capacity---------------------Type- 'Mttte�i''al=l -------------No. Compartments-------- -- ---------------.--6.it 1 Distance to nearest: Well------------ - - - ------�.oto4d n--------------------------Prop. Line-,-------------- ---------- LEACHING ------------------.- - LEACHING LINE [ ] No. of Lines------------------------------ Length of each line._ ___..___.__Total Length.____"---.---.-------------- ---_--._.0 'D' Box-----------_Type Filter Material------ -----------Depth,Filter Mater-ial--1---------------.------- ---------- -----------------------� e Distance to nearest: Well--------------------- -----Foundation----_`------ ------�'Property Line__.----- ------------------------0 I { . � _ SEEPAGE PIT [ ] Depth.___._ "._-_.--Diamete\-______------___-Number___�______.- i--______Rock Filled, Yes EJ No❑ �.., _X r / ) Water Table Deptht � oak.Size - = , Distance i to nearest: Well.- _-A ----------< Foundation------------------------- Prop. Line- ------------------------- REPAIR ------------------------ REPAIR/ADDITION (Prev. Sanitation Permit#__ .,,}__-- -------------------------- _ ____________"---_,_,: Date------------------------ ---".--.--_--- Se tit Tank (Specify Requirements)---- — ff -F- Disposal Field (Specify Requirements)- 3-- 7o.! Lam/ -. W` 4� -i --- ----- .. '----------------------------------- = = ' z !i I� -------------------`----------------- ----- --------- -----g----- - i� (Draw existin and re'qui'red additibn 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 Law's; and Rules and 'Regulations of the San Joaquin Local Health District. Home owner or licensed agents signature certifies the following: - "1 certify that in the performance of the work for which this permit is issued, I shall not employ any person in such mariner as to become subject ) Wor n Co pensation laws of California." Signed----- ` Owner BY--- ------`---- ------------..------------ --- ---------------------------------Title------------------ ------------------------------------------------`------ I (If other than'owner) ' ! FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------------ -- -------------------------------------------------------DATE._---------l- ..l i 7 f------- --- DIVISIONOF LAND NUMBER -------- -------- ----------------- ---------------------------------------------------DATE---------- - -------------------- ---ADDITIONAL COMMENTS---`---- ----- --- --------------------------------------- --------------------------------------------------- -------------------------- ---' ._ -L___ _ "�. - ----------------------"`=1---------- - -------------------- ------ - ---------------------- ---- -°----------------- ---- -- --- - ------------. +. \ --------------- f .------_____ .__ _ _ __ _ _ - f N ---------------------- ------------------------------- __ FinalInspection bY:------ - -- -- ---- -----I----------------------------------------------------------------------Date--- EH 13 24 SAN JOAQUIN LOCAL HEALTH DISTRICT F&5 21677 REV, 7/7!