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FOR OFFICE USE: FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT �j h -- �---.'---------=-------- - -------- - No� ./.."�3. -. (Complete in Triplicate) Permit .�. ........................................................ y Date Issued... ..-`-:3d-7 ... ...................................................... This Permit Expires 1 Year From Date Issued Application is hereby made to.the San Joaquin Local Health District for a permit to construct ond'install the work herein described. This application is made in compliance with County r inance No. 549 and existing Rules and Regulations: CO3 40 JOB ADDRESS/LOCATION. ... ...........� _ H CENSUS TRACT Owner's Name. !/!!..,_... ----is----- - .... . ----Phone_ ?6% Address �7�� . Phone_ - '- y. a -------------- .License _p ;----.w.t�.._--.... Contractor's Name_____... Installation will serve: Residence Apartment House ❑ Commercial ❑ , Trailer Court ❑ r Motel ❑ Other----.--. ---_----------_-- ----------- Number -- --- -Number of living units------- -------Number of bedrooms..3-'...Garbage Grinder------------Lot Size---- -9... '--- ...... Water Supply: Public System and name-- ------------ -------- Private Rte Character of soil to a depth of 3 feet: Sand ❑ Silt ❑ Clay ❑ Peat ❑ Sandy Loam ❑ Clay 1-sa+aa` �' Hardpan ❑ Adobe ❑ Fill Material__ .... .. -If yes, type---_--------------------- (Plot .....- .(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,) - PACKAGE TREATMENT [ SEPTIC TANK l Size - !YXSX9-I--------------------------------Liquid Depth._y--.--'-.....-------- Capacityl. OO_....--Type-"-AP-f .Mate'rial. ..........No. Compartments.----- o '---....�-..........Gr Distance to nearest: WeIL:-,5 .9..... ........... foundati6n- . -'-- ..Prop. c4 LEACHING LINE ( No. of Lines....----�-------------- Length of,each line_. 5�--` . -�- ..Total Length -..._ 1�.----.----.-------- !' ~ D' Box._..`.�Type Filter Material 5!.��l�..Depth Filter Material_....---/�-- -------------------- f r Distance to nearest: Well..-'—D................. Foundation......�.......-....-.-Property Line.-- 14- SEEiaAl&&44 E9 Depth.-AO!-----Diameter�.X*4P-.---.Number-.--------o ------------------ .r ��. Rock Filled Yes No ❑ Water Table Depth.__...------ �Q.�--.-.-'------- ---------• ----Rock Size.-�x Distance to nearest: Well_-- ---' ------------------Foundation..__.,�_Ca...._.......Prop. Line.,,..-.-_.- -- "'----- REPAIR/ADDITION (Prev. Sanitation Permit.#----------------------------------- - -----Date.-.:...........-.----------------'.""--------) Septic Tank (Specify Requirements).------------------------ ------ ...... Disposal Field (Specify Requirements)_.........._......I- - -------- ------------------------------- ---------------- ------------------ ------- ;,7--------------- (Draw existing and required addition on reverse side) I hereby certify that I have prepared this application and that the work wilt be done in accordance with San Joaquin County Ordinances, State Laws, and Rules and Regulatioris 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 become sublet orkm?gPp Co pensation laws of California." Owner_ . . --- ......... /� Title (If other th caner) FO DEP TMEN USE ON Y APPLICATION ACCEPTED .--- -DATE .._........4--------- —- ------------ . -- ....... DIVISION OF LAND NUMB DATE-------- COMMENTS-----------_- ._.....__ ------- -- ........ - .-...---- . --- .._ --------- -- ---- - Date.... / - ^ ..7 .. ... ._ Final Inspection by: -------C EH 13 24 SAN JOAQUIN LOCAL HEALTH DISTRICT ��{ $EvJ 776 3M