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FOR OFFICE USE: FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ` -------- 7 60 / (Complete in Triplicate) Permit No. ..-..-'_ ---- -------------- ------ ----------- --------- -- v Date Issued-.---__'S..-. -This Permit Expires I Year From Date Issued 1 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: JOB ADDRESS/LOCATION.- . Qd)-Z� D-20--------- --------------a�'T'a��-�--------CENSUS TRACT --------1--------//-- Owner's Name---------- -------- t---- ---------------------------------------------------------- Phone- Addressie P r ------------City- .il .r -- -- ---- --- ----zip------------------------------ Contractor's Name-------------- s. -.._-L.l I2.R� .` 3�hQ--- �E --------- License #a 3_�:-------Phone-� _ - _07- ---- Installation will serve: Residence "f, Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other---------------------- r--- ---- ----- ----- I �i Number of living units:_]-___-_-___Number of bed rooms-___._2�-Garbage Griinder-------------Lot Size-----�A--_ �_;Z-_j-- ------------__--.______.__ Water Supply: Public System and_name 'P---------------i {--f�J� '1rcfZ_ _yP ------------------------------Private ❑ Character of soil to a depth of 3 feet: Sand ❑ Silt 0 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 tanker„seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ } SEPTIC.TANK\..[.]' Size--------------------------------------------------P - iq�i _Depth 3r--------- Capacity----- l TYPe r. Materia) ----- ---- ---------- -No. Compartm"e'xnts -:.J Distance to near4-Well-.-”--- - --------------------------------Foundation--------------------------Prop. Line---------------------------- LEACHING LINE [ ] No. of Lines-----------_---- -jN---,-,Length of each line-------------------------------Total Length..--_.----------- .--------------------- 'D' Box------------Type�Filter-Material--------------------Depth Filter Material--------------------------------------------------------------- Distance to nearest:'Well----------------------------Foundation----------------------------.Property Line-----------------------------------0 SEEPAGE PIT [ ] Depth----------------Diameter---------------.----Number-------------------------------- Rock Filled Yes ❑ No 133 Water Table Depth - ' ----------- ----------------------------+-----Rock Size_ ----------------------------------- rk. Distance to nearest.-Well___`_'_------------- -----------------------=Foundation--------------.------ -__ Prop. Line--------------------------- ✓ 4;r REPAIR/ADDITION (Prey. Sanitation Permit#--[------- --------- -.,--__._ _.____-_____-.Date-._-..-----.--.-.----._ / } Septic Tank (Specify Requirements)__ -- -r--,� ----- ------------------- CC, _� - --_-__-- _- ------ Disposal Field (Specify Requirements) a. y ----- -- -- � ^--- ----------------------------------------------- r �. --------------------------------------- t ------- - ---- -- ------------- -------------- ----- -------------------------------- -- - . (----- - = -`------ ; ---- "--- ----------------------------------------- I (Draw existing and required addition on reverse side) I hereby certify that I have prepared this application and that the wok will be done in accordance with San Joaquin County Ordinances, State Laws, and Rules_and_Regulations of the Son�Joaquin Local Health District, Home owner or licensed agents signature certifies the following.- "I ollowing:"I certify that in The performance of the work for which this permit is issued,rl shall not employ any person in such manner as to beco a sub" ct to Workm pn's Compensation laws of California." Signed AAV' -4$,f�r�--�#--��_ ---Owner s BY TitIe S'tT 7W"r ,-- ---- --- ----------------------- (If other than o ner OR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY DATE = ' --------------------- DIVISION OF LAND NUMBER. -------------- --------- --------------------------- DATE.------- - --------------------.------ ADDITIONALCOMMENTS------ ------------- ------------------------------------------------------------------------------------------- ------------------ --------------------- =5=- 7------------ ---- --------------------------------------------------------------------------- ------------------------------ ------------------------------------------ -- - - ---------------------------------------------------------------- ------------ -------------------------------------------------------- Final Inspection by:- �' Date t� -- �------------- EH 13 24 �AN JOAQUIN LOCAL HEALTH DISTRICT ��F s 21677 REV. 7/76 3M 13.-