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p FOR OFFICE USE: FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ........................... ... _._. ---••• - Permit - (Complete in Triplicate) ........................ cl I Date ................................................. 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.-..- . f =July :------ .............. _.-.... -. __....--..-._..-.. ,...-....-Phone1 t._. Owner's Name.-.- .-..',.. J. Address`.��.a----- - -- ----- - .__.._..-.. .............,-.,.City/ll./4 /........ ......... zip ................ e� Contractor's Name._ -....' ... f . .-�'' �-_._...._•__.. - ......-... License `a ...... '. . Installation will serve: Residence Apartment House E] Commercial Commercial Trailer Court ❑ Motel ❑ Other .. .............:................._....... Number of living units:......,- ---- .Number of bedrooms... A Garbage Grinder_.. .......... Lot Size__ -.-.___/-...-. -..------- Water Supply: Public System and name_ ...................... ,.................... .-. -_ .-------------------- ...... --..... _.. ------------------ .Private Character of soil to a depth of 3 feet; Sand ❑ Silt ❑ Clay_❑_ `Pelt ❑,,,,,-Sandy Loom X Clay Loam ❑ Hardpan ❑ Adobe ❑ Fill Material` r .. ___.If yes, type... ._--___....--_.... (Plot plan„showing size of lot, location of system in relatibui.ldings, etc, must be placed on reverse side') NEW INSTALLATION: (No septic tank or seepage .pit; permitted if public sewer is available within 200 feet,) ..NI PACKAGE TREATMENT (} SEPTIC TANK [ ] j Size _.. `'� -k 5.-•-- ------ -- _-- Liquid Depth._ Capocityl�Pr `'�"TyPe `q a I - ---..:' ..:.: No-••C-oml�p_artments.-:...5-? . ------------ 1� Distance to nearest:,,Well--- ---. ......... .. ... ..-----... Foo� }dation-_L� .j_ ..... Prop. Line __,..--..��....-.--.q, LEACHING LINE ; f 17 __ e !� Total Len 1 [ ] No. of Lines•...r_:.---_--_..Length of each line._.._ --------.•_-__-- gth----- ..d 'D' Box i ...... Material l00,Yc,2Depth Filter Material_.. --..._/d._-.. __ ................. . .............. . Distance to nearest: Well ...cl.. -'t .--..-�.... Foundation.,_,. ti� V.. Property Line.- - !6w..� .. ---. SEEPAGE PIT [ ] Depth... ___Diameter'--_--...... ....Number. _._______________•.------.• Rock Filled Yes E] No ❑ F Water Table Depth-._ ----- -................. ..;......................... Rock Size.. .......... ..... ;1- i .Distance to nearest. Wbll---........._..__........ ................ Foundation._.__...4.,._-...-....._.Prop. Line. .......................... REPAIR/ADDITION (Prev. Sanitation Permit #n.• ...........:.... ............ ............... Date ............ - ....... __-.-..-.. ......... Septic Tank (Specify Requirements)..-........................__......._:_............ ................... ----...............--_- _ ............. :; Disposal Field (Specify Requirements) -•-•---••-----'-'-----• .,.._..----------•..................... .. v -------._...•.......................................---..-_........................ ........................ -..-................. ........ i ----- ---- -- -- ---- -- -. .......................................................................... ................ -....... .......... _-....... -.- ...--.--.------ .�- (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 become subject t Wp man' -Compensation laws of California.” Signed._ ✓ .....Owner ..Title_ ` (If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY.- ' ......................DATE DIVISION OF LAND NUMBER............ ...... DATE .... ...------ ..... ....... -._... DITIQNAL COMMENTS.--....-..-. __.. -..- .......................... -• _w _- --- 'A ,K ,.. ... - _ M._. _ ..-. _ ... — '� 40 - .............. ........................ ... ............. ._...---•--• ••-•- ...... ..__...- ------ - . -------------- Final Inspection b • _ ...... .......Date.. 7- ........ EH 13 24 SAN JOAQUIN LOCAL HEALTH DISTRICT F85 216!7 aey � �f