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FOR OFFICE USE: f FOR OFFICE USE: APPLICATION FOR SANITATION PERMI i". (Complete in Triplicate) Permit No...7 '.-. I`. ..............................I- --- ------- Date Issued --��' -.. .'� -•------------------- -- -- ....-..-...._ This Permit Expires 1 Year From Date Issued ---------- -- ,o-plication is hereby made to.the San Joaquin Local Health District for a permit to construct and install the work herein described. I s application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION....... . J CENSUS TRACT _ _. ._. C vner's Name.... . " p -- ----- •--- ------.Phone..... ------•------- ---- - -- --- Ci ---- ................. ........_-Zip-_------------- ------------ ('-ntractor's Name......... 7&,4�_ _ ................License #-3�r 1./1.-. .Phone_ ..,V o_.� P-7.. I_,,tallation will serve: Residence A Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other............ ....... ........................ 1 I amber of living units:.......I.......Number of bedrooms...._- Garbage Grinder------------Lot Size--..------ ..�3 /- -- --------- --- - - \Porter Supply: Public System and name._ -_ ------...-------- -----------------------------..Private Character of soil to a depth of 3 feet: Sand ❑ Silt❑ Clay ❑ Peat ❑ 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.) l' W INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) P-mCKAGE TREATMENT [ ] SEPTIC TANK [ ] Size .. L/lL .. �..�---------------------Liquid Depth.-=l---------.---- --.-- Capacity.1-6.190----TYPe--,j...... ......Material . 1�i,�---------- No. Compartments----�------------- ----- -(j' Distance to nearest: Well.--_-----....-_... ...... ---- ---------Foundation......_. -- -- . Prop. Line....._....__ ---.------ LEACHING LINE [ ] No. of Lines t3 .....................Length of each line ----.L�D--------------- Total Length ./-V-9----.--.-.--._----------- 'D' Box-.f.......Ta Filter Material--- Depth Filter Material-------..._ �J Distance to nearest: Well...........I.i .......Foundation----------------------------Property Line....---------_- ........ SEEPAGE PIT [ ] Depth.... ..�� -Diameter.._- Number......- -------------------- j Rock Filled Yes No (� I WaterTable Depth----•--------•-- -- --•-------- ------ --- ----•• ---.Rock Size--------- e ------------------------ Distance to nearest: Well....-. �........... _.......Foundation------------- - .. Prop. Line-------.----.-..... ----- li F PAIR/ADDITION (Prev. Sanitation Permit#----..-.--_--.------.--.- --- - - - -----•••Date.._.--_---------..----. -- . . --- ------) 3Zptic Tank (Specify Requirements).--- --•-- ----------------------------------- -- --- - .-----------•--------------------- nisposal Field (Specify Requirements)_ .......-........... .........-..._ - ..... --•-----•-----.-.....---••--•----•---- --- ................... ................. - ------ -------------------- - - - ------- -- . . ..---.....--..-- ---- . ------. -- --.....------- . --- ---------I——........... ...........-- ..--- ••---------------------- (Draw existing and required addition on reverse side) Lereby 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 r`)nature certifies the following: ',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." Ined.. Pf�ert - Owner L Title.. .. ..... ...... .. ._..... . ---............. ( f han owner) OR DE RTMENT USE NLY APPLICATION AC�DN D BY_..-.... . -. .. -... .._.. DATE ........... . ..1 ..- --- -- )[VISION OF LAMBER... ........... ... . ...... ... •--- - DATE_----------------------- )DITIONAL COMMENTS................ _ . • . ----- -- _... � ...----- ----- --•----------------------------- --- ---- --... .......... ------------------------------------- ....... - - 1 � _nal Inspection b Date... Ess 216 .�� . . - _... 77 REV. 7/76 3M EH 13 24 SAN JOAQUIN LOCAL HEALTH DISTRICT