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FOR OFFICE USE: FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT , 7 --------------------------------- ----------------- -- f1' �f (Complete in Triplicate) Permit No_______________________ -------- ----- d�„_,,,�•_ Date Issued..._��."_>c_. _.7J -.--.__"-__"___________ ___11.__ -.. ---_----------__ This Permit�Ezpires 1 Year From Date Issued --- Application is hereby made to the San Joaquin Local Health Diltrict forts permit to construct and install the work herein described. This application is made in compliance with my Ordindnce No. 549 an xistiing Rules and Regulations: !Q7/ JOB ADDRESS/LOCATION �i' _ ��__ -- — ----------------- ._-......----CENSUS TRACT&iu�c_ > -----. a i _ f' p" Owner's Name J�1E�__ _�. - I'lC� .�_ Z ,e ��o�R. o-P.4I- ----------- ---- -----PhoneP � ZZ . Address--- ---- .��.-� 2 City----- . Zip------------- -- -------------------------- -1Contractor's Name__:_.Z., _f^_.ar!___._�-�..,.__-_.______{License #_�.��___Phone.__.?"��_`�. _ _ Installation will serve: '; Residence. Apartment House[] Commercial ❑ HTrailer Court ❑ a I { ; ote ❑ Other . '--------------- M. ---- _ I Number of living units:_ _ -_Number! f_bedrooms Garbage Grinder-----.__,__-Lot Size___ : � Water S pplyfPubli4 System and name_.__ ` ' = - ------------ -------- ---------------------------------------------—Private Character of soil to ca•depth of 3 feet: Sand ❑ 'Silt❑ Clay ❑ Peat 0 Sandy Loam ❑ Clay Loam El ? r - ' 1�Hardpat�.�Ad`ob $: Fill Material-------------If yes, type----------------#---.------_--_-- (Plot plan, showing siie.of.-lot, location 'of.system ;'in relation to.wells, buildings, etc. must be placed on reverse side.) — E � `, ,I` Ci. ate., ..t i ; NEW INSTALLATION: (No"septiCta`nk or seepage pit—perrnitte-d-if pP blit sewe�is available within- 200 feet,) �, PACKAGE TREATMENT--{_],': TIC TANK Size___ __________________ Liquid Depth__ __. _____ _ 3 _._Material_ -- _ ~No: Com a�tments_____ ______ ____ - Capacitxf 2. YPe r-i e f P / --- - - - Distance to riearest;.WeLL__ e ________.___ _____._Foundation-=.-1----- --------__.:Prop. Line_____aP_ _._.__.__.__. I `-georr LEACHING LINE $d.--,,.No.,of Lines-n•�---'-------_--:::Leng"ofeah line.---"�Q -- - -"--.Total Length.----.1!��-------------------', -- • --- --------------------------------- D,Box._'__:.i.'__�T,ype Filter Material "__Depth Filter Material__Distance to nearest: Well._ __ undation- "Q__.________'__..Property Line___ SEEPAGE PIT De• `- " . e/.. . .__ ___ p 1_tl c__._'�_Diameter__ - _ Number_______ _-- --------------- Rock filled Ye No A. t Ei,Water � rTable.' � - Rock Size ll_Zf1- i DProp Line------nearest:Well._:...__ �� _ ------ ' REPAIR ADDITION•(,Pre J Sanitation Permit:#�1------------------------------------:-----------_Dat6-------------- --------- -------- Z Septic Tank.(S eafYRea '� . -) ------ �l Disposal Field (Speci jyiRequirements)----------------- - -`-----------=-------------------=-------------------------------------------- ------------------------------= t ----- r' ] }{Draw existing and required addition on reverse side) v # I hereby certify that I have prepared this application and that-the work will be done in accordance with San Joaquin County 4 Ordinances, State Laws-sand Rules and Regulations --of the San Joaquin Local Health District, Home owner or licensed agents signature certifies the following: t � �r•t-e.: - "I certify that in'the perfo an a of the wo for which this permit is issued, I shall not employ any person in such manner as to become b�_ �_Z s Compe s tion la' s f Calif nia.7. i Signed--- �i --- ---=------ — .,.. ' - - '-Title----- - -BY------------------------------------------- ._---------------- ------ - (If oilier f than owner) , ' FOR DEPARTMENT USE ONLY a � APPLICATION ACCEPTED.•BY-_.___ --., - -- -- ---- ----- ------------------ -- : -- - - -----------.:---DATE.-3 --- - DIVISION OF LAND NUMBER ---------- ----------------------------- ------_.DATE------------------------------- ------------r--- ADDITIONALCOMMENTS- --------------- --=--=------- -----=-------------------------------------------- -- ------------- --------------- -------------------------------- -----------------`-------------- _ ----- - ---- ----- = ---------------- ------------------------------------------- r ~ � __________________--------------- __________ -_________.""-____._-""__""_""""__-__--_---"._"""""""--"_--- __"--______.___.______-. ----------------- __ a „4 -------------------------------- - ------------ --------- - - ---- ------ ---- --- -- -- -- Final Inspection by � 1 : ` ..�-b .tea -------------- Date �. 7--- - - ---- F" 13 24 SAN JOAQUIN L C t HEALTH DISTRICT Fns 21677 Rev. ane 3M g,