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i FOR OFFICE USE'S FOR OFFICE USE: f APPLICATION FOR SANITATION PERMIT Permit No.7. '_:. 4..7. (Complete in Triplicate) - ----------------------------------------------•--- t, Date Issued-%§ ............................... 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 Re ulations: JOB ADDRESS/LOCATION.. J� 9��. . /�} 7i�J"L� G"Q., GENS TRACT.......... ............. Owner's Name._ . .......... ......... ........ --------• ==----- -• --......-.------.--Phonelalr .,3/ -,C, Address----- ------- ..........Zip__9T37-e-------- Phone.-- License #z, _...... _ - . - Contractor's Name....... � r_,F�, 5 � ' � Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other--.......... . .......... --_-----------. .-::._Number of bedrooms Grinder_-------.:--Lot Size.._......-.-.- ------------- Number of living units:...../-. (n Water Supply: Public System and name ...................... _.--Private Character of soil to a depth of 3 feet: Sand,E] Silt❑ Clay ❑ Peat ❑ Sandy Loom ❑ Clay Loam ❑ Hardpan ❑ Adobe ❑ Fill Material . -__ If yes, type....................... (Plot plan, showing,size,of-lot,jocation of system in relation to wells, buildings, etc. must be placed on reverse side.) NEW INSTALLATION: (No septic tank ar seepage pit permitted if public sewer wer is available within 200 feet,) ..Size..-..'_6_ ize:: - �r L�_�j --•---- - -------Liquid Depth.._`�..�1 ------- - PACKAGE TREATMENT ( ] — SEPTIC TANK [ I a. � �- Capacity.f.TPAW-t3--- .Type.......c Mate-rial ...------�---- -•-No. Compartments --.--------------- - -------- 7-prop. ------- 4 - Distance to nearest:,Well------ - . .--..-Foundation.-.--' !C�. rop. Line-.----..'................... Total Length - f LEACHING LINE ( ] No. of Lines ....v2.___..._ _.._..Length 6 each lino.... . 9 'D' Box... . --- - Type Filter.-'Material /,-,j�r 15A*epth Filter Material-----..l rr-------------------- ---- ------- --------- 7- Distance,to nearest: We11.._1��' . .77 Foundation-----��_ ..Property Line.....f+�..r�-�.----7. SEEPAGE PIT ( ] Depth----_ .......:.Diameter....................Number-...._.___..------------..---- Rock Filled Yes ❑ No ❑ Water Table Depth._----_.----------- ...... :-----Rock-Size----------------- ...----- .. 1 Distance to nearest: Well --- ----------- ------.Foundation.-- -- ---........:..Prop. Line -------....... �.. REPAIR/ADDITION (Prev. Sanitation Permit#.---'-----:- ------- ------ - -- ----------Date.-------=-••--- -----..._..... ------- ) Septic Tank (Specify Requirements)---------- -------- ---------------- ---•--- ---- --. .- - ----------------- --. ._. ------ ........... ---- ---- • Disposal Field (Specify Requirements)................4._---: .._ ---.---------•- --- ---------------- --------- --1 --------- .......... . .....---- ...................................... ------•---------- 4 . (Draw existing arid.'required addition on reverse side) T an that the`work will be done in accordance with San Joaquin County I hereby Certify that I have prepared this dpplication g Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local_Health District, Home owner or licensed agents signature certifies the fallowing: "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 subjectt Wo an's rompensation laws of California." ----- -Owner Signed--------�C_.' - r By----------------------- ---- - - - - - ..... Title...-- ----.----------r....--------- --- .... (If other than,.owner) FOR DEPARWENA USE ONLY APPLICATION ACCEPTED BY..: ....DATE . ---------------------- DIVISION OF LAND NUMBER --------- --- ---------- -- ....DATE.----- --------- ...... ... - --------------------- ADDITIONALCOMMENTS----------- -------- -- ...... --------------- ----------- ------- - °.......------...........------------. . ---.--- ---------- ---------------------- -----._-....-_ _ ........._. r -_ .. ----------- - --- ......---- -. --- _... - - j j Final Inspection b ----Date..._. ..:._ -- -- f� _ . EH 13 24 SAN JOAQUIN LOCAL HEALTH DISTRICT = F& 21677 REV. 7/76 3M