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FOR OFFICE USE: _ FOR OFFICE USE. ..,, APPLICATION FOR SANITA"rlON-ARMIT (Complete in Triplicate) Permit No. ... -:_nA?9.-.- Date Issued.�l..- ••----•-••----------- ------- .................... This Permit Expires I Year From Date Issued i 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/LOCATION-----f... .. ., - _ (t�- ... --------------- _ ---CENSUS TRACT-------------------- Owner's Name... . ----------_..Phone................................... Address..... Zi .................... Contractor's Name..... . . License #. L� LI. _....Phone-� !t/.T.� Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other_.. ------------ Number of living units:._--j ..--------Number of bedrooms-......Garbage Grinder------------Lot- Size.... .. .. ".............. . .. Water Supply: Public System and name--.-.............. ------------------••r---•--------- -- ............ ---...----------.Private t Character of soil to a depth of 3 feet: Sand Silt❑ Clay ❑ Peat ❑ Sandy`Loam ❑ Clay Loam ❑ [ Hardpan ❑ Adobe Fill Material - If yes, type.. ......... 1 (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,) i PACKAGE TREATMENT [ ] SEPTIC TANK ( ] Size.trx_'__Xlo..........................._ quid Depth --=.....-.- .Li p I Capacity- -----TYPe----4 -- - Material. ..........No. Compartments.. :. -- ------- - Distance to nearest: Well_. .Q... .. . Foundation...._to. .:.Pro Line..'! LEACHING LINE [ ] No, of Lines -AP .-...--.-- Length of each line. -7�.. Total Length I ..... - . � 'D' Box Type Filter Material- ---- Depth Filter Material-- -----------------_-._...-..------------.-.-----.- -----•-- Distance,to nearest: Well... ............... Foundation----/Q............-...-Property Line------------------------------------ SEEPAGE PIT [ j Depth--- ...._ .....Diameter....................Number--- -------- -------------------- Rock Filled Yes E] No EII Water Table Depth----------------------- ----- -- - -----.. ......------.Rock Size.................... -------------------... 1 Distance to nearest: Well...........................................Foundation. ........Prop. Line------------- I REPAIR/ADDITION (Prev. Sanitation Permit#--------------- .......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: "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 i to become subject to Workman's Compensation laws of California." Signed_,.,v- .. Owner --- •---•-•-- ---------------------- Title............ ------------ ----------------------------------------- (If other than o ner) ! FOR DEPART NT Ug ON Y APPLICATION ACCEPTED BY......---- ----.-- DATE ....�1-0� '�8 DIVISION OF LAND NUMBER......................... . ,�, rco a DATE---------------- ---- -- . .. ---_..... ADDITIONAL COMMENTS_. --------- ....... ........ . -------------------- ------ -------................................. -- ------------••------ ................ - ---- -------------- ---------------.-- ---- - ---------- --................. -- ............. ................. ..................... ...................• -•--------- ----- ----------------------------------------------- ----------------- ._.......I....... ---------------------------- .............-- .. -------- -- Final Inspection by:....-. .. l L.�_ ( Date... - f=7 ...... J -- EH 13 24 SAN JOAQUIN LOCAL HEALTH DISTRICT F&5 21677 REV. 7/76 3M