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/FOR OFFICE USE: FOR OFFICE USE: ,. APPLICATION FOR SANITATION PERMIT-6 -� -7-------------------�,-3b- - - Permit No----------------------- to _7.7__�651 ------- 36.._------ (Complete in Triplicate) - - - � - - >> --- 1 1--(( �jj Date Issued--G' .....--•-� i-V __ 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 C-ouunty- Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION- S�¢ C-> /_--G�% _ '� ----------------.CENSUS TRACT----------- -------------------- iez Owner's Name-_0 ------ ------- ---------------�--------I--- -/------------------�__Phone-------------------------------------- 74z - -- �`------- ---City-- --------------- AddressZip 9 ".td f Contractor's Name----- -- - ----------- - -- ------------------------------- -License #__,;�7_71X J7----Phone---- -----`-5----------`------- Installation will serve: Residence' Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other-------- ------------------------------------- Number ------------------ -------- -----Number of living units:____f-_-------Number of bedrooms---9-----Garbage Grinder------------Lot Size___-_I_-----_______--------------------------------------------------- WaterSupply: Public System and name----------------- -----------------.-----------------------------------------------------------------------------------------------Private 5' Character of soil to a depth of 3 feet: Sand ❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ Hardpan ❑ Adobe 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,) Q0 PACKAGE TREATMENT [ ] SEPTIC TANK [ ] Size-----------------------------------------------------------Liquid Depth--------------------------- \11 Capacity---------------------TYPe-----------------------Material------------------------No. Compartments----------------------------------15 Distance to nearest: Well-------------------------------------------Foundation--------------------------Prop. Line ______-________-� LEACHING LINE [ ] No. of Lines---------------.-------------Length of each line--------------------------------Total Length----------------------------------------- 'D' ____________--____---______________'D' Box------------Type Filter Material--------------------Depth Filter MateriaL_________________._____________________----_._____-----_-- Distanceto nearest: Well_ _----_-_______Foundation___._-___________-______Property Line____________________________-__.' SEEPAGE PIT [ ] Depth----------------Diameter--------------------Number-------------------------------- Rock Filled Yes ❑ No ❑� WaterTable Depth---------------------------------------------------------Rock Size------------------------------------------------ Distance to nearest: Well.------.._-__-----------------------------Foundation--------------------------Prop. Line______________________---9� REPAIR/ADDITION (Prev. Sanitation Permit#_____________________--_______-----_-----------_.Date__-_________________________-__________-__} Septic Tank (Specify Requirements) /- 33 Disposal Field(Specify Requirements)_ ---- ----------- ---01- --" --------- - ---------------------------------•-------------------------------------------------------------------------------------------------- ---- .0�-------Q"'S - ---'- ------------------------------------------- - (Draw exis ng 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 the performance of the work for which this permit is issued, I shall not employ any person in such manner as to becom ject to W man's Compensation laws of California." 410 Signed -- ---- -Qwv- /' - Owner BY ----- F i�/�, Title---- ------ other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY_ n, - ___DATE.___E DIVISIONOF LAND NUMBER--- ---------- ---------------- ----------------------------------------- -------------------------DATE----------------------------------------------- ADDITIONALCOMMENTS---0� ------------------------------------------------------------------------------------- ------------------------ -------------------------------------------------- ----- -- ----- ------------------------------------------------------------------ ------------ -- ----�- inalInspection by:--------------- ------ese------------------------------------------------------------------------------------------Date------ -----�"'- ,�, H 13 24 SAN JOAQUIN LOCAL HEALTH DISTRICT F&S 21677 REV. 7/76 3M