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FOR OFFICE USE: FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ---------------------- =-------------------------------- Permit No.. ---------- Date 7'- 3 ! (Complete in Triplicate) I --------------------------------------------------------- Date Issued--- ---`_( _r77 I, ..................... ---....------------------_--------- 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 County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LO ION `�J � __ CENSUS TRACT ----- -- - - ------ ------ ---- s a Owner's Name.---- -~9W -- --- ----=---- --� Phone -. ' - + - - - -------- --- ---- ----- --------------------------- -- -- Address 1l r F.....'City -- Zip t Contractor's Name._ _______ _ _____°------,License #.a 7l 3�-----------Phone Ao< -X f__-._. i Installation will serve: Residence Apartment House.E] Commercial ❑ Trailer Court ❑ Motel ❑ Other------------------------------------------------ Number ----------=-----------------------------=--Number of living units:-_--- ------Nurri;ber of bedrooms=_ _Garbage,Grinder ._ oSize_____ :�=J ----------------------------__2 s Water Supply: Public System and name- ---- -------- � — = Private ❑ Character of soil to a depth of 3 feet: Sand ❑ , Silt❑ Clay ❑ Peat ❑ Sandy Loam ❑ Clay Loam ❑ ` Hardpan'0 Adobe , -'Fill Material............If yes, type--------------------------- ---- i (Plot plan, showing size of lot, location of, system in relation to wells, buildings, etc. must be placed on reverse side.) ' NEW INSTALLATION: (No sepc,tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ ] . SEPTIC TANK j ) + Size-----------------------•---------------_-------------------Liquid Depth.-------------------- i- r t a Capacity: --------- = -Type P ------------- Distance'to nrest: Well .t' _ _-T e----------------- ':.`_ Material-----------------------_'_.No. Compartments ea _:__.___ f ' = Foundation Prop. Line LEACHING LINE [ ] No. of Lines.--- Length of each line___----._.__'r_, ___-",-.Total Length _-„________________________________ _ ► 'D' Box-----------= Type Filter Material--------------------Depth Filter Material------------------------------------------------------------- - Distance.to nearest: Well----------------'------------Foundation-------------------- Property Line-- --------------------------- --OV SEEPAGE PIT [ ] Depth----------------Diameter-----------.-------._Number-----------:--_---__ ❑ --_ - -- j Rock Filled Yes No Water Table.Depth--- ----- ------ ------ ----------- Rock Size------------------------------------------------ Disfdnce'to nearest: Well-------------------------------------------Foundation ------.Prop. Line--------------------------- REPAIR/ADDITION (Prev. Sanitation•Permit#---------------------- ---------------------------Date.--------------------------------------------_! Septic Tank (Specify'Requirements)=... _._ _ - - rr �� = L i Field (Specify Requirements Q /' ----------------------- Disposal -J -- . --- - - _----------- --- - ---------------------------------- ------ --------------------------- ---------------------------- . ---------------- - ---- (Dr'.cw existing and required addition on reverse side) I hereby certify that I have prepared 'this'application and that thework 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 whichithis permit is issued, I shall not employ any person in such manner as Sign """' 1 lifornia.". ' togbec . or an s Com nsanon la sof Ca =Owner 1 By-=----- ----------- -- Title--4/71L - i (if other than owner) ' FOR'DEPARTM'ENT USE ONLY. APPLICATION ACCEPTED BY-----=--- - - ---- - -- - _ - --------------------------- ----'-----------------------------------DATE.------- -_2------------- _ -------------------------------------------------- , DIVISION OF LAND NUMBER---------�/ ----------- DATE ---------- -- -------------------------(-- i ADDITIONAL COMMENTS_.__ -- _- � ___ __________ _ _______ _ -------•--------------------- ---- ------------------------------------- --------------------- ----------------- ----- --------------------------------------- ------------------------------------------ r --------------------------------- - ------------------------------------------------- j f Final Inspection by ----'------ ----------------------------------- ------------------------------------Dater -1� - /_ � l /�S. +3 24 SAN JOAQUIN'LOCAL HEALTH QISTR.ICT F&5 21677 REV. 7 31M