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FOR OFFICE USE: FOR OFFICE USE- APPLICATION FOR SANITATION PERMIT (Complete in Triplicate) . Permit No �. 7 ---------- --------------------------------- ------------ �' - - - - '1- ' at sued 1� f- " cK. -z r. _"_ Date Is ----�lS7 ---------------------------------------------------------------------------- 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,--- -- --.- ----- ` --_ ------.CENSUS TRACT-----------------I---------- Owner's --------Owner's Name------- - _ -- -- ------ -----Phone------------- ----- = ------ - Address---------- -- -- --------- �,1.- - ------- ------ Contractor ---- City �:.- Zip i Contractor's Name------ .... .. -------� :-------------- ---------------i--- License #- -7 S- � Installation will serve: a Residence �Apartment House ❑ Commercial ❑ Trailer Court ❑ i Motel E] - Other------------ - :-F-A n ---------------- age ------ ---- -� Number.of living units:_.:/.""._ Nf tuber of bedrooms--_�--Garbage Grindexs.-_ _.:__Lot.Size.__3�!. ___ :------.--- Water Supply: Public Systemandname--------.:-------------- -------------------------- -= ':----------------------------------------- -- --------- --.-----_--- ---- Privat i*, ' y� Character of soil to a dept of'3 feet: Sand ❑ Silt[] Clay ❑ Peat,El Sandy;Loam ❑ 'Clay Loam fo Hardpan ❑ Adobe ❑ Fill Material__ - __If yes, type_______________________________ (Plot plan, showing size of lot, location of system in relation to.wells, b60&ngs;.etc. must be placed on reverse side.) ,. i., t i. .,*... '•-. NEW INSTALLATION: (No septic tank or' seepage pit permi itted if pubtic sewer s,available within 200 feet,] -. r s ' 4 PACKAGE TREATMENT [ l SEPTIC TANK �d' Si e__yS- ----- A _#'_______=__--__-_Liquid Depth.________ _ i ` - _- _ Noompartmens- ____-Ca Capacity. TYp ----- ---Mat6riUl. - .-_- ------------ --- Distance to nearest: Well.____ - � Prop. Line- .7)--- --..._..:.=-_-•-----=- Foundation-- d---�----------- - -- � ---------- ---� LEACHING LINE [LNo. of Lines........./-„______________ Length of each Line----/d- --------- ---- Length ---��:._`,_,______-_.-_ D' Box---------%__Type Filter Material:_51 ._-_* epth Filter Material___-_ F ; J bis#ante to nearest: Well ! C ._______Foundation-_. _ -___--______Propeity Line-: 7-5 SEEPAGE PIT [ K i'De th. '__.5 --.Diameter... Number___--.---1___________________ ; Rock Filled Yes No❑ p + I r� 1 Water Table I'Depth--------t_6T--------------------------------------Rock Size_.+-, -------------------- ' ~e,.ares Well-_ � jos -- �� +---� �.Distance,to nearest: Well.___-_[__�� _________.__-----------Foundation°_�/____---------- __Prop- Line___-_-_ -----__f_- REPAIR/ADDITION-(P.rev:.Sanitation Permit#--c-_---'--------------------------- -----Date------ -.`--------------------------f SepticTank (Specify Requirements)---------------------- --- -------------"----------------' =------L--------------- ------ ---------------------------------- -------- Disposal Field (Specify Requirements)------- ---- ---- -- -------------------------=-------------------------- -------------- ---- ----------------------- ------------ ------------------------------------------------- --- -------------------------------------- -------- ------------------------------------- ' -------=--------- -- ------------------------- -------------- E (Draw existing and required addition on reverse side) I 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 in such manner as to 5 �M!uN of California.”- p Si bed me/� ec to. WCompensation laws p- Owner it - /� BY ` �------------------- Title (If other thanowner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-------- --- --- ----- y - ------------------- ----------------------- DATE._ .� �`= DIVISIONOF LAND NUMBER --------------- --------- ---------- --------------------------------------------------------- DATE-------------------- ---------- ---------" ADDITIONALCOMMENTS-------------------------------------------------------------------------------------------------------------------------------------------------- ----------------- ---- . ------------------------- i ---- -------------------------------------------------------------------------------------------------...--------------------------------------------- ----------- - ------------------------------------------ ------------------------------ --------------------- - -- 1 --- - - Final Inspection by------------ ------- ------------------------------------------------------ J EH 13 24 SAN JOAQUIN LOCAL HEALTH DISTRICT "°'s,b» EV. 7176 3M