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FOR OFFICE USE: FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT__ 77— ------------ _ (Complete in Triplicate) Permit Date _________________________________________________________ This Permit Expires I Year From Date Issued Application is hereby made to the San Joaquin-Local H olth istr`ict for apermit to construct and install the work herein described. This e with Co ty in ce No, 549 nd exist' g Rules and Regulations: is .- . -_ � � _ _ _ - �R - .. JOB ADDRESS application ern m rant ^� , pp , _ p . IY __ / `� CENSUS TRACT----------------------------- f Owner's Name-- -- ------------ - ------ ---- - ---- --- --- --------- Phone _��/ Y7 Address ------------------------ -- -- 77 Zip Contractor's Name +R-�C _1�- ------------ ______ _________________License # t__Phone___-_ _____- Installation will serve: Residence Apartment`House.❑"Commercial'❑—Trailer Court ❑ Motel ❑ Other--- -------------- 1 Number of living units:-----l-----------Number of bedrooms__ ____Garba grinder____ -- --- t Si e_�J ----------------- ----------- ------------------ \ - - tom/__ $ - Water Supply: Public System and name_________________ . _ �_ �. - -_-Private ❑O Character of soil to a depth of 3 feet. Sand ❑ Silt ❑I Clay ❑ Peat ❑ Sandy Loam Clay Loam ❑,;�.; (f 1 Hardpan ❑ dob FiII Material- If yes, type_-.________ --.____-------- (Plot plan, showing size of lot, location of system in relat(on-to welt"s`bu�ildings,-etc-miist be placed on reverse side.} ' NEW INSTALLATION: (No septic tank or seepage pit permitted.if'public s�r is available within 200 feet,), PACKAGE TREATMENT [ ] SEPTIC TANK ize.`r`j�--- ------ ________Liquid De h �-�__-___ Capacity-l-r , TYpe i� 1 ,;»-f� No.�ompartments-------- --- ' M tergal-_ Distance to nearest: Well_An'—-• Foundation-___ Prop. Line. �'_Q � i LEACHING LINE Na. of Lines_- / Leng of a h4ne�t `_� `•________-..Total Le th.__ o.c.. ::.______________f'� 'D' Box-----L-'--Type Filter Materi _ ..... Depth Filter aterial_ ____ ___________ ---------------- =` ___._ oundatior>�_. ____ r ! I Distance to nearest: Well -___.____ _ __-__�{__.__Property Line_._______�__ SEEPAGE PIT Depth- Diameter-_ Number='_�___________________________ h Roc Filled Ye �No ❑p n Water Tablet Depth---- --------------------------- ---- -`±----------Rack Size-----`-- r................ ------------- _ Distance to nearest: Well_ _- -Foundation_ _.--_____ ---------'----.ar--- -----�-- --- -------=--Prop. Line --- ---- -- REPAIR/ADDITION (Prev. Sanitation Permit#________ ------ __ -----------------!__________.D _ -. - .--__----} Septic Tank (Specify Requirements)---- ---- ---- -- --- --- --------- --- - -- -- ---------- - - ------ --------------------------- Disposal Field (Specify ReV -e- - ments)-------- ______ ____ __ ___ ____ ___ --------- !-�-- - -------------- ---- - ' o� - ----�---Q -- - ------------- j � , ----------------_----------------_---__-------------------- ____-_____-_______-__-__--_-______-_-_______ --.____.--_-_-.___- --------------- (Draw existing and required addition on reverse side)' 11 I hereby certify that I have pre pared'this"dlolicationand that the work—wil1'Fie done'in aEcor7lance with San Joaquin County Ordinances, State Laws, and Rules ant! Regulations of the San'Joaquin Local Health District, home owner or licensed agents signature certifies the following: "I certify that in fhe a ante of the work for which t ermit is issued, I shall not employ any person in such manner as to beVbt tLff or en's C*o�w;n w Cal ,"inTner Sign -- �-��--- -.1ifornia �..� BY -------Title - - ---------------- ------------------------------------------- (If other than FOR DEPARTMENT USE NLY APPLICATION ACCEPTED BY-------------- --- -------------------- DATE.-_j'�' 7_5/'77 DIVISION OF LAND NUMBER -- ---------------------- _- DATE---- ---- ---- ----------- ------------------------------- --- - --- ADDITIONALCOMMENTS --------- - - --------- - --- - ------------------------------------------------------------------------------------- --------------- -------------- ------ --- ------- ------------- ------- ------------------------------------- ------------------------------------- ----------------------------------- 7 -------------------------------------------- - - --- ---- ---------------------------------------- - ------ ------------------- - --------- ------------------------------------------------------------------------------------------------------------------------ Final Inspection by __Date_../2-_: --------------------- - - ------------------------------------------------------------- EH 13 24 N JOAQUIN LOCAL HEALTH DISTRICT F&S 21677 REV, 7/76 3M