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FOR OFFICE USE: FOR OFFICE USE; APPLICATIO,_N FOR SANITATION PERMIT ------------------------ -- . ............ Permit No..7f_.'S 16.. (Complete in Triplicate) -----------•------------ ----- 6 "- 7- 7/ Date Issued....." •--_---- This Permit Expires 1 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 incompliance with County.Ordinance No. 549 and existing Rules and Regulations: 1pa&---------------- CENSUS TRACT ...----..._... --- ..--- JOB ADDRESS/LOCATION../- """- .�7.... ..-/-(--- Owner's Name._... _..... ..----• ....... .........•_ .........Phone----....---- ------- ........ Address....----.... - - ----- --- -- City------- ...... Zip------- ----"-------- Contractor's Name.---- '(� License #._ r !_.J�.Phone_.. Installation will serve: ResidenceApartment House r7Commercial E] Trailer Court ❑ MLI ❑ Other----- ---- --- ---- - -------=-- ------- Number of living units:....... ,------Number of bedrooms... ...Garbage Grinder------------Lot Size--- ~Q j - -•. ........... - .. . vate Water Supply. Public System and name--s------ ala - --- Pri ❑ Character of soil to a depth of 3 feet: Sand ❑ Silt ❑ Clay ❑ Peat ❑ Sandy Loam ❑ Clay Loam A Hardpan ❑ Adobe ❑ Fill Material.. --. ---.If yes, type-•-•-------------_---_--- ` J (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc, must be placed on reverse side.) NEW INSTALLATION: (No sep#ic tank or seepage pit permitted if public sewer is available within 200 feet,) O PACKAGE TREATMENT [ ] SEPTIC TANK [ ] Size -.( ,.--/C-- -- --{0---- -- ......Liquid Depth .- --" 0 Capacity a4� l... No. Compartments_.....�---------------------- Distance to nearest: Well-...----- ..._Foundation..._ :�.--..- _... Prop. Line.... ^- ---------" - LEACHING LINE [ ] No. of Lines ......_/........-_.......Length of each. line...... Leath - - - ---- ------ 'D' Box--../.....Tyfpe Filter Material_...... ..... ... Depth filter Material...-..� -- ..... Distanc&to nearest:1Nell-.------ ---_- Foundation'.._.---......................Property Line---.--.---- ----- T7etE� SEEPAGE PIT [ � p .:.. - . ...:.� t Rock Filled Yes �j No❑ .Diameter............ ....Number............. i.-....-. r Water Table Depth-------------- -----------------------Rock�Size------ /_ --------- r i Distance to nearest: Well-------- ---------------- -----------------Foundation................... ......Prop. Line .......... -- - REPAIR/ADDITION (Prev. Sanitation Permit#------------------------- --------- ----------- ---Date.._--=----•-----.----.- - ----- -----1 Septic Tank (Specify Requirements --- ----------------- .. .... )-----...#--- ---------------------- ----- --- . i Disposal Field (Specify Requirements)----- ............... -•----- ...... -- " • -------•------------------------ - ------------ ------- ............ ... .--- ....----------- --------------------- -......-- (Draw existing and required addition on reverse side[ I hereby certify that I have prepared tris 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 to become subject to Workman's Compensation laws of California." Signed '.. - Owner J� By--------- . _.'Title... ------------------------ {If other than owner( F DEP RTMENT USE ONLY APPLICATION ACCEPTED BY.......... .... .. /!� .. -. ------ .-..----- - --..DATE . -------- --.�.7...7:... ...... = ...- - . DATE DIVISION OF LAND NUMBER.-- ADDITIONAL COMMENTS. L--------- ---- --- ----- "...... . - ---------------•-- ... 17 1 ... _ - �" - Final-lnspecfion b '"_r�-------- --- ------•--- -- --- ---Date..._... --- --- --_... _ ...-- Y ...-- ----- -. ... --- - ---- EH 13 24 SA JOAQUIN LOCAL HEALTH DISTRICT F85 21677 REV. 7/7h 3M