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FOR OFFICE USE: *APPLICATION FOR SANITATION PERMIT` FOR OFFICE USE: q (Complete in Triplicate) Permit No...7..-'111_ ---------------------------------------- Dare Issued.--7-.a7.,7F _....................._.. 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 Regulations: JOB ADDRESS/LOCATION--------^ .?._ (�/_ ).� _ _.-. ./ 111' . zf�� .,.. _._CENSUS TRACT. ___----------- Owner's _. ....Owner's Name.. ./IL -------------.----- ......Phone..... Address ./ -- --- - - ---------------City -.. GA. 40�i ------Zip ------------ Contractor's Name . License #.`� � ...Phone --�j.s��. .'__.�� / . Installation will serve: ResidenceApartment House❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other - --------------------- Number ---- -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 ❑ Hardpan Pg 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.) NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) GE TREATMENT [ 1 SEPTIC TANK [ 1 Size - - - - - ---- ------------------Liquid Depth --------------------- PACKAGE ----------------------------- Capacity ------------------ Type_--_----------------Material_ - ----No. Compartments --------- -- 6 Distance to nearest: Well---------- ...._._------------------------Foundation--------------------------Prop. Line.;----------- ---- --------- LEACHING LINE [ 1 No. of Lines._------------------------:.:Length of each line ---...------ ----------------Total Length.-------------- _....._.- S 'D' Box----------Type Filter Materigl-------------------.Depth Filter Material------------------------------------±.---------------------d Distance to nearest: Well--------,..,rc;_----------Foundation.................._........Property Line---------.-..-____._.___-..-.._-- SEEPAGE PIT [ j Depth_------_ -----Diameter--------------------Number------------------ ------------- Rock Filled Yes ❑ No❑ Water Table Depth--- ----------------------- -----------------------------Rock Size---- -------- ...------------- ----- - - Distanceto nearest: Well --- .-. .-..Foundation .... -_. Prop. Line---------------------------F REPAIR/ADDITION (Prev. Sanitation Permit# i _ Date _.l! Septic Tgnk (Specify Requi ements)__'- _ _____ ------ ---------------------------------------- -------i------------------------- Disposal - -------------- Disposal Field (Specify Requirements) ( ---- ---------- .- ----- ./. .. xa:L � ?� a� Fix ...... ........ -------------- - (Draw existing and required addition on reverse side) 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, I shall not employ any person inisuch manner as to become subject tokmpn's Compensation laws of California." c _ YI- Signed _C� -�1 y2 /, / --------------- .....Owner By / _.Title ---- Qf other than owneriiif) OR AEPARTMENT USE ONLY APPLICATION ACCEPTED BY _ ------ ------- ------------ -DATE _ ------ DIVISION OF LAND NUMBER ,.. i_. __..._DATE _. ADDITIONAL COMMENTS_ - - .._ ---- ------------------------------------------ - --------------------------------------- ---------- ---- - - ........ -------- - - -- - ------- - ------ -------------- Final Inspection by:- - -- --------------------------- Date.- -/---7 ---------------- EH 13 24 SAN JOAQUIN CAL HEALTH DISTRICT F7 b} REV. 7/76 3M