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FOR OFFICE USE: FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT J a f -APermit No.7e� ,. _.-.. ---------- ------ {Complete in Triplicate), I/ - - Date lss ...... This Permit Expires I Year FromDate 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 Ordin ce No. 549 and existin ales and Regulations: JOB ADDRESS/LOCI ,ION-_ �-- ------ _ - CENSUS TRACT ----- - ---- - - -------------------------Pho -- Owner's Name. . - �� Address------ zip f � �� `� = y _License # J � Phone-_ --------------- Contractor's Name--------__ ____ __ _____ �/ Installation will.serve: Residence Apartment House C&nme'rial E] Trailer Court. [11Motel ❑ Other----------== `.. _----- - ------ �f Number of loving units:. of.bedrooms...,,_-Garbage Grind r- --.---- -_.Lot Size.--....-.___.__----_.------ - _- -______.._-_------__-_-- 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 F] Adobe E] Fill Material._-- -__If,yes, type................ --..._ r (Plot plan, showing size of lot, location of system in relation to wells, builcl'+ngs, etc. must be placed on reverse side.) A NEW INSTALLATION: {No'septic tank or seepage pit permitted if public sewer is available within 200 feet,] V PACKAGE TREATMENT t' ] SEPTIC TANK [�] Siie. :-)-- -" - Liquid Depth--------------------------- ------- Capacity ---------Material'-----------------------No. Compartments.--------i--------------------- w Distance to nearest: Well------------------------ l Foundation_-----------------------Prop. Line LEACHING LINE [ ] . No. of Lines---- ---- ----- Length of each line-------------------- -----=--,.Total Length... { ' YPeFMateria --------------------- yi p ,ter ----=------------------- -------------- ation-Distance to nearest: Well FoundIProperty Line- ---------------------------------- De th--- ----- -.Diameter „-------- --~--- SEEPAGE PIT E l P Nurriher-------------------------------- Rock Filled Yes ❑ No❑ -- ---------- ----------- 7' Rock Size P - — ; Foundation ter y .'� �- Prop. Line -. D Atari eatol nearest: Well_'-.___ -" F REPAIR/ADDITION (Prev. Sanitation Permit#--------------------- --- - -- ti- ,---pate_-__-----------------------------':---------- ], Tank (Specify Re uirements)------ ° - --- ----------- ------------------------------------------------------ Septic --- ----- I P Y q ��°� ,�° r - �4 Disposal Field (Specify Requirements) ✓L/_...- --CSL.R---------� =r� '�____c�_"��_..--__". .-,-.._ �` ...._ r -------- - ------------- ------------------- ------ it -------------------------------------------- -----------------------------=-------------------------------------------------- - ------ ------- --- t (Draw existing and required addition on reverse side) I hereby certify that 1 have prepared this application and that'the work will be done in accordance with San Joaquin County ' and Regulations of-the'{San Joaquin Local Health District. Home owner or licensed agents Ordinances, State Laws, and Rules signature certifies the following: f certify that in the pe rforniance of.the.work for which this permit is issued, I shall riot employ any person in such manner as to become subject to Workm s Compensation laws of California." Signed..--- ----- = :Owner .. ------- -- BY -- --- - -- -- --- - ---------- Title--- ------- z II other thaWowner) FOR DEPARTMENT USE ONLY- DATE. - - ---- - APPLICATION ACCEPTED B --- - - ---- ATE DIVISION OF LAND NUMBER._----------- ------" D ADDITIONAL COMMENTS-------------------- - ------------------------------------ ------- -------------------- --------------- --------------------------- ------------- - -- f ---------------- --------------------------•------- ----:- ----- -- --- -=- --- � _ ---------- - ------- lG -------- -----` Final Inspection b Date. � -----�- - EH 13 2a SAN JOAQUIN LOCAL HEALTH DISTRICT F&S 2lh77 REV, 7/76 3M