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FOR OFFICE USE: FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT 7�- ------------------------------------- Triplicate) Permit No._ k ---------------- - (Complete in --------------------------------------------------------- Date ------------------------------------------- This Permit Expires 1 Year From Date issued Application is hereby made to the San Joaquin Local Health District fr a permit to construct and install the work herein described This application-is-madein-compliance with-County-.Ordinance-No.e549.-and_existing.Rules_and-Regulat.ions: -- -- �� G-Y _ .• ------ ------.CENSUS TRACT------------- ------------------- JOB ADDRESS/LOC I�ON��Ii��.lL� .�- -- -�----------- - - -- ---- --- ---- = -- . - --- Owner's Name -----, ------ FPhone $ - Address _ o J .--- ----�� ` _ ..-- ---- --- Zip - - --- ---------- z_--- Contractor's Name- rte ---- Zzl Phone License #-- -------------- -- Installation will serve: Residence Apartment House❑ Commercial ❑ Trailer Court ❑ { - R - . • Motel [�w- Other ------- ----- ---------- ---- ------•- Number of living units:_--___-_ __.___Number of bedrooms__.____Garbage-Grirtdea____ ._____.Lot Size_____________f.- :-A-.----------------------------------- .- AZr Water Supply: Public System and-name________..___..------- -- ------- _ _- '4 -- Priv d ;`� ctc�4e. � _--------.-- 4. Character of soil to a depth of 3 feet' Sand ❑ -Sil1❑ 11,Clay'❑I� Peat ❑ Sandy Loam ZClay Loam ❑ Hardpan ❑ Adobe'❑ Fill-Materidl "-----__If yes, type------------------------ ------ _ .�.-T F (Plot plan, showing size dflot-location of system in relation-to'wells, buildings;'etc, must be placed on reverse side.} NEW INSTALLATION: (No septic tank or see age pit' permitted-if,public sewer is available within 200 feet,) PACKAGE TREATMENT [ J SEPTIC TANK SizeT�-- - - --- ---------------- Liquid Depth ' -------------------- Capacity/2l-------------- Distance e T e 'e�"�---Material` ---No.Compartments----------------------------------- -,-- �----------------- ------ - --------- Type Distance to nearest: Well\--------- _ham/41 ---- --'-r-_Foundation--- :----L Prop. Line--------------------------- LEACHING LINE [ No. of Lines-------__-_ ------ I_.Len th--of.each]ine._____-__-- - Total Length.___�� --------------------------- s .'D' Box__:-_1----Type Filter Material;----- - ----Depth Filter Material-----/�`---------------------- -------------------------- ! Distance to nearest: Well--- Rock -.Property Line__.___ N-------------- r i [ ] Depth._riJ/ . _ -/--�- umber---------- � ---------------- Rock Fillack Yes No❑ Water Table Depth,--e %- -/-' , er, 4-. -- N p ------------------ -.-,---.Rock Size Foundation_- 1 - Prop. Line__-5/_ - Distance to neprest: Wel!-____.__:-1 --- / REPAIR/ADDITION (Prev. Sanitation Permit#---------t--------------------------=--- ----------Date------ ---------------------------------------} Septic Tank (Specify Requirements)-.,-- :- -----= ----------------- ---------------------------------------------- -------- Disposal Field (Specify Requirements)__,-____- -------- -------""""- ------------------ ---- --- - ----------------------- -------------- ------------------------------------------------------=-------:------------------------------------- --------------- (Draw existing 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: S t not employ any person in such manner as "I certify that in the performance ,of-the work for which this permit is issued, I shall to become subject to Workman's.Compensation laws of California." iE Signed------ -------------- -- -- - ----- Owener `" = - (If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------G---- - -. - -------------DATE -3-"-- - ` - DIVISION OF LAND NUMBER ------------- ----- - DATE - ------ --- -- ----------------------------------------------------- ------------------------ ADDITIONALCOMMENTS------ ------------ -------------- -------------------------------------------------------------------------------------- -------------- ---------- F ---_-------------___________________________________i-_•___- _______________________________________________ ____________ _____________________ _________________________________________________________________________________________________ ___ ' __ ___ __________________________________________________ _ --I __ _.._/ Final Inspection-by: ._ ---------------------- ------- a e - - -- - - - --- - EH 13 24 SAN JOAQUIN LOCAL HEALTH DISTRICT F&5 24677 REV.7176 3M