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FOR OFFICE USE: ' .��' s FOR OFFICE USE: t ti PPLICATION FOR SANITATION PERMIT ---------- ------------- *j y n (Complete in Triplicate) Permit No..__ ------------------- -- - ------------I----------- ` Date Issued----- .:� 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 and install the work herein described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Re ul do N. .f.. JOB ADDRESS/LOCAT _. --r�- 0-�------ -4- ----- - ------------1411 . ACT----- ---------- ................ Owner's Name......_. -� - �� - - ---------- ------ --Phone---- -------------- Address------ ------. f City Zip Contractor's Name , ±i4[-j_,�lr_ - 9...,, t�_icl4cense Installation will serve: Residence Apartment House [-] Co Ipmartial EJTrailer Ebrrrt- . Motel ❑ Other. .-- � � Number of living units:-----/-------Number of be rooms.-a`X_.- _Garbage Grind `ter.-. tLot Size..--�� ._.. Water Supply; Public System and name__..___ .. -----------------------------------------Private Character of soil to a depth of 3 feet:' Sand E] Silt E] Clay ❑ Peat E] Sandy Loam' Clay Loam ❑ Hardpan ❑ 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.) ti NEW INSTALLATION: {No septic tank or seepage pit permitted if public sewer is available within 200 feet,) Q PACKAGE TREATMENT [ ] SEPTIC TANK Siz __ .__� ------------------ �._�..................Liquid Depth......67_1*----------Q Capacity Ga i TYPe/ ,-Material-. I. Compartments------ .------------- ------ p Distance to nearest: Well—JS-— --------- ---------------Foundation..:-/_�................Prop, Line...,S.__------_------- -- LEACHING LINE Na. of Lines-------.,...............Length of each line..-.....p.-- .- r g e- Total Length. --- ------- -- D' Box---/ Type Filter Material_.ef ...Depth Filter Material.:__/9__F.---------------------------------------------- Distance tonebrest: _____________------------Distancetoneorest: Well__ATV_ ----_---Foundation-----_/Q-- -_ ----- - Property Line ---- r t r SEEPAGE PIT � Depth-,��: ,�Diameter_- LL_�_____---_----Number..-..-..1-�Z____-___----______-_ Rock Filled Yes �(' No ❑ P / f o Water Table Depth--- -=------------ ---------- ------------ Rock Size------�----------- ------------------------- - Distance to nearest: Well--- .r/C ---------____----------Foundation.._... .. ..:......Prop. Line_._�.�..__...__.__.____. REPAIR/ADDITION (Prev. Sanitation Permit#__ ________________________________________________Date---------------------------------------------- 00, ._____________.___ __._ _ j - ---- ------ --- Septic Tank (Specify Requirements) - --------- - ---- Disposal Field (Specify Requirem nts)---- r--- _-�- . -__ ______ ... ---------- - -----------------------------------��...�1-------- ►----- --- --- -- ----- - ---- - - - ------- - --- --------------------------------------- {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, 1 shall not employ any person in such manner as to become subject to Workman's Compensation laws of California." CLA°ri,I;,L>S SE r= SF. � SERVICE Signed -------- --- ----------------------Owner2ns,05 r BY Title - -- -------- {If other tlia wner) FOR DEPART T USE NLY APPLICATION ACCEPTED BY--------------------------------- - ----------DATE.. °� ?3-?` ------- DIVESION OF LAND NUMBER.----------. -------.DATE------------------------- ADDITIONAL COMMENTS------------------ --------------------------------------------------- .- --- ----------------- ----------- ------------ ---------------- ----- ---------------------------------------------------- ---- -'----- -------------- -----•-------- -------- -------------------------------- ----------------- -- ------ - ------ Finaf-lnspection by: Date-------------------- ---- -- ----- ----- --------------------- ------------------ ---------------- ------------------------- ---- - - - ------- EH 13 24` SAN JOAQUIN LOCAL HEALTH DISTRICT F&5 21577 REV. 7/76 3M i • r