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.. -- - -----FOR OFFICE USE: FOR OFFICE U5t': _� PPLICATION FOR SANITATION PER !T. � tri e j PeNo,. rmit f _ (Complete in Triplicate) s as ti. -- p --------------------- - .......... --.- This Permit Expires 1 Year From Date Issued Date Issued-v 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.. -- ...........CENSUS TRACT. -- - --•............... ...... qq Owner's Name.- Address... --- . Cit zi y.. -------------- ---- P--...----- Contractor's Name....... ... �. � ......... License #-9A1 ? Phone.-.-a.6----------- hG7 lnstallotion will serve; Residence ❑ Apartment House ❑ Commercial Trailer Court ❑ Motel ❑ Other-- ..................�------ ...---- Number of living units:....... ------Number of bedrooms.....3_ .Garbage Grinder............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 I Hardpan D AdobeX 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 p Ii sewer is available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK M /' 4.. ! Liquid Depth.._ .+r.._.....__ ,$ize ------------- Capacity..1. -?7-------Type... L ....... Matexia No. Compartments_. - ..---------------- Distance . -Distance to nearest: Well.....-.1 �--- - oundotion------ .0 -----.......Prop. Line.....-. ....... LEACHING LINE No. of Lines .....J----------------- Len f e ----- .. __._ Total Length �. �-:.................----- 'D' Box---- `...... Type Filter Materia ....... .... .....Depth F' rial._..-.� _... .._.. ------------------------- -------- 7L Distance to nearest: Well..-.f .....-..-. tion---- . ...f`-.........Property Line.....7�......_....................... SEEPAGE PIT [ ] Depth.. Diameter.....................Number...... ----------- Rock Filled Yes ❑ No ❑ Water Table Depth-------------- --------- - ---------------- ---Rock Size. - •----- - -- - Distance to nearest: Well------------- -------------- ndation--------............_ ....Prop. Line ` REPAIR/ADDITION (Prev. Sanitation Permit#---------- ----- ........ ate--------------_.............. .......-...-----} - - ------ Septic Tank (Specify Requirements)..._..... _ ^ ' l --- Disposal Field (Specify Requireme sl ----- --------- --- ---- . ...................................................... O ------ -- ---1.7 -------- -- ---- ---------- raw exist g and required addition on reverse side[ I hereby certify that I have prepared this licati n and that the work will be done in accordance with San Joaquin County Ordinances, State Laws, and Rules and Regu ions of the San Joaquin Local Health District, Home owner or licensed agents signature certifies the following: "E 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 subject to Workman's Compensation laws of California." Signed-----.. .,....,. .. Owner BY �'LJ ...._ Title.......c� -------- -- -- ------ (If other than owner[ FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY -.- "V. _' DATE ..._........ 3. .. DIVISION OF LAND NUMBER.. ..._..DATE......................_.... - ADDITIONAL COMMENTS.... ............... . . .. ... Final lnspettlon b .............................. Date........................ ......... EH 13 24 SAN JOAQUIN LOCAL HEALTH DISTRICT FLS 21677 REV. 7/76 3M