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FOR OFFICE USE: FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT 7G- --- _��3 -- ----------------------------------------------------------- {Complete in Triplicate Permit No.-_ ..� ._ 7 ' . _ ------- � Date`Issued-- - ------ ---- 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. 519 and existing Rules and Regulations: _ p --- JOB ADDRESS/LOCATION =- --K4e ---CENSUS TRACT.------ --- y . Phone- ---- - -------------------- Owner's -F- -- ---- Owner's Name ------ CityAddress- /5. L Zip _ License S 0�r - # . '-- ----------- Contractor's Name- ! Installation will'serve: Residence Apartment House.❑ Commercial El Trailer ^Court ❑ ' *- Motel ❑ =Other----. =--------- ------------- Nu' ber Number of.living units:_____/__---Number of bedrooms_ =--Garbage Gr-index- __Lot.Size_- __ _ - -- Water Supply: Public System and.name----------------------- r^......--:.�------------ Private' 1 Character of soil to a depth of 3 feet: : Sand Silt E] Clay E] Peat❑ Sandy Loam El Clay Loam ❑". . ,- i • Hardpan F1 � 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...tank or seepage pit permitted if public sewer is availab�te within 200 feet,) d� ' 1 ; c_IN- Liquid Depth ------------- ' PACKAGE TREATMENT [ ] SEPTIC TANK Size -- ---- � q p L' acity. c Q ---:-Type ' _-Material_ - --No. Compartments----------------------------------- CapF. 'Foundation -d------- Pr Line r .'Distance to In Well-.._ en-----_-- F --- p' -- 'o_ .- ------Total Length.I NG LINE No..of Lines- ..---------------:---.Length.of each line- -- g f ----------- LEA .. - - Depth Filter Material-------�-------------------------�----r �. D' Box__. Type Filter Material-i ._e_ - O� Foundation-.III------------- ---.Property Line--- ------------ ---------- - Distance to nearest: Well_-_,�_______-__..._ ' y.j. SEEPAGE PIT [ ] Depth- }-------Diameter--------------------Number------------------------------ Rock Filled Yes ❑ No ❑ Water Table Rock Size---------------------- -- ' Pro Line---------------------- -- - Distance to nearest: Well------------------------------------- ---------Foundation-------------------- p. REPAIR/ADDITION (Prev. Sanitation Permit#------------------------- -----.pate------------ -------------- } Septic Tank (Specify Requirements)-------------------- ------ ----------------------------- Septic = . Disposal Field (Specify Requirements)-----------=------- - ------------------------ -------------------_. --- ------ ---- - ---------------------- ( -------------------------------------------- 1 S (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:-...—-_i "I certify that in 'the performance of the work for which'this permit is issued, I shall riot employ any person in such manner as to becom ject to Wo _Man s.. Compensation laws .of California." ' - r --- Title-- .--Owner - ---- -- --------- --------- -- I y Signed-- ------------ned Title B g ` (If other than own6r) FOR DEPARTMENT USE ONLY' Is 10 APPLICATION ACCEPTED BY- ---- - ---------------------------------------- ------------ ------ DAT yATE . . -- ----- ----------- ------ DIVISION OF LAND NUMBER.--------------------- , ADDITIONAL COMMENTS.................... --- -------------- --------------- ------------------ ------------------------- _ __ ----k-------------------------------------------------------------------------------- ------------------------------- ------------------------ - ---- -- -- -- ------- ------ -------------- --------- -- ----------------- ------------------------------------------ -•---- -- - --------- ------------ Final,ins ection b >�= -- - - -- .Dat - EH 13 24 SAN JOAQUIN LOCAL HEALTH DISTRICT F&5 21677 REV, 7/76 3M