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FOR OFFICE USE: FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ---------- Permit " < s,(Complete=in Triplicate) ------------ -------------------- - --- Date issued.- I-°Z----��-- 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 C my Ordinance No. 549 and exist• g Rules and Regulations: t -. � F JOB ADDRESS/LOCA ION-, ----�� . , - --------- L.7----- t----=--.-.CE-NSUS TRA !C'T'r/---`--- -- ---- Jam---- , Owner's �Name.: - ---- --- -------------- .� - ----------- ---,-=�--------k -_ -- - hon � -------------------------------- -------------------------- � - ...---'---- l nit .- �. . /. t =City� J Zip4 � .. Lnhone-3- _._Contractois Name O4 # Instal lation-will'serve: Residence El Apartment House E] Commercials. (Trailer Court ❑ ----- - - - _ e ... . :.. . .:.. ,�....._. ..�- Mote:l�❑� Other--- � -----------------------------•. �. � ,, . ., Number of.living.units:---------:------Number of bedrooms--------......Garbage Gr-index------------Lot,Size---, .----------------------------- Water _ `Water Supply: Public System andiname--------------- --- ----------- - -- -. .-------- ----------------------------------- ---- Private Character of soil to a depth of 3 feet: Sand ❑ :Silt❑ 'Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ t Hardpan Ll : Adobe' Fill Material ----If yes, type------f`.t—_------------------ (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 4or seepage .pit permittee�d//i if sewer is available within 200 feet,) PACKAGE TREATMENT SEPTIC TANKJ Size f -----------Liquid Depth - ---�- j-- ----- )- Campa`rtments-- ------- : r00Capacity - _- Tpe -i - p 7 , f � t _Pro Distance to nearest. Well----- � -------------------------Founda'tion.__ U_ p. -Line--------,-- :F I LEACHING LINE '� No. of Lines....-_./:-,.__;,.._,-_,._,__.Length of each _Total Length.,_._ --------------------------...� :'D' Box._,__.____.Type Filter Material_�f. K ._Depth Filter Material-------� - 4P Distance to nearest: Well :�r,Q� Foundation -_ Property Line--6-- '.___.___.__ 11 SEEPAGE PIT [ ] Depth_. -----------Diameter--------------------Number---------------------------------- I Rock Filled Yes ❑ No i Water Table Depth--------------- -----------------------------------------Rock Size----------------------- -----------------< (e r Distance to nearest: Well ------- -Foundation---------------;::�--- ..-Prop,TLine,, '= REPAIR/ADDITION (Preva.Sanitation Permit# ''� � .----:-°------ _ - - -- -- ------ - --Date t..._ ! � ------------ � • ----- Septic Tank (Specify Requirements).....:._. _. ------- Disposal Field (specify Requirements)... --------------- ----------------- ----- - - ---- ---------------------- /* 7-_ ------=r--- i • i 1^ . -• , orf ----------------------------------------------------;--- --------------------------•--------- --------------------------- ----------- --- -- ------------ # s � l y y. i '1 _ ._ .M e :. (Draw existing'arid required addition on reverse side) r il 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 tlie'work'for-which this'permit is_issued, I shall .not employ any',person in,such manner as to beco blect to Wo all's .Compensation•,:.laws_of_California.'�_�: .. • ! k 1 Signed-.eo- '' r = QQ Owner i .. g c� i Title + herthan( foter)By FOR i DEPARTMENT'USE ONLY APPLICATION ACCEPTED; 6Y- 11*' - - DATE1 7 - --------------------- DIVISIONOF LAND NUMBER:-------- -- -------=----- -------'--------------------------------------------------------------------DATE-------------------=------------- --.----} ADDITIONALCOMMENTS-------------------- - ----------- --------------=------:---------------=-- ------------------------ ----- ------------------ ---------------------- ----- - -------� -- --- ---------- ------- ---------------------------- -------------------------- -.------.----- - ----------------------------------- - - ---- - ------ - -- -- ------------------------------------------------------------------------------- -- --------------------------------------------------------- Final Inspection by:. = '" - --- - �'.-------�------------=------------ --------------- bate.. � _4- �� EH 13 24 AN JOAQUIN LOCAL HEALTH DISTRICT F&5 21677 REC. 7 W J.