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FOR OFFICE USE: FOR OFFICI; USE:., APPLICATION FOR SANITATION PERMIT �� (Complete in Triplicate) Permit No---............=--L)-..0...y... Date Issued-. ........ ......I........................... .---- ----- .... 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: GG f JOB ADDRESS/LOCATION_...._./. -U.... ��_I -.�-� -... .CENSUS TRACT. .---...-- " y� Owner's Name........JP/2...._..l`Yie., �1 ..rte..... - ........ Phone _...3T(�-.._ Address ---- . -- --�_ ? ......_.. Cit __Zip P s Contractor's Namelfal/ �-- Q� `-`..._.License # /? all�r Phone., 4 ...... �J Installation will serve: - Residence X Apartment House ❑ Commercial ❑ Trailer.Court ❑ Motel ❑ Other...-- ---------------------- -- Number of living units:.......I- .Number of b drooms......_.....Garbage Grinder_-._.'......Lot Size............... ...__--.:_._........,r . Water Supply: Public System and name.. .._... ...... -------------------..Private ❑ Character of soil to a depth off3 feet: Sand ❑ Silt❑ Ca Peat ❑ Sandy Loam 171 Clay Loam ❑ Hardpan ❑ Adobe Fill Material . .... ..:. es. t pe--------------------------------- i (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 or seepage pit permitted if public sewer is available within 200 feet,) [ 1 .., PACKAGE TREATMENT ( } SEPTIC TANK. Size ... Liquid Depth.................... ........ Capacity •-- --- .Type:....--- - ....Mafe-rial---.......... --------- --No. Compartments------ --- i Distance to nearest: Well---------.-------------- --- - - ----------Foundation......... . ............. .Prop. Line----------............---:Z) LEACHING LINE [ ] No. of Lines ........... ...........:.Length of each line -------------------------..._Total Length .. ................................ .�!`t p 'D' Box.___........Type Filter Material..:..:. ..De th Filter Material-- --------------- ...... ----------------------------------- . ...- ---..Depth Distance to nearest: Well...............:............. Foundation---- ........................Property Line.................-..--.-:-......... I SEEPAGE PIT [ ] Depth............ ..Diameter---------------.... Number_.............. ------ Rock Filled Yes ❑ No x. . Water Table Depth------------___--------_...............................Rock Size---- -- ------- •-• E Distance to nearest: Well.---------.--- Foundation. .....Prop. Line:_:..`..................... REPAIR/ ADDITION rev. Sanitation Permit#---•............................... ---------__Date..........__-..-------.--. ----------- } ptic-Tdn pecify Requirements]....... .... & - . /. ' .. ... .. Disposal field {Spe fy Begin a encs)_ : .-4 .. ------- ------ -- ------------ --. ... -- . > {Draw existing and required addition on reverse side) I hereby certify that 1 have prepared this application and that the work will be done in accordance with San Joaquin CounP;1 Ordinances, State Laws, and Rules and R_egulations of the San Joaquin local Health District. Home owner or licensed agentg signature certifies the following: ' "I certify that in the performance of the work for which this permA is issued, I shall not employ any person in such manner as to become subject to Aork 's C ensati laws of Colif Signed --.:.... caner t By---'` ............ Title.-- -------...- ------------ -- - ----------- --------- ot er than owner] FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BYRUAY ----- --- DATE `.. ......... ......... -------- ---- ----------- -- ----- DIVISION OF LAND NUMBER _..._ ---------------DATE.......---------------......--- -----..------_-- ADDITIONAL COMMENTS _ .......... ------------------ .......... ................ -------------------------- .......... ------------ = . ...................-.................. ........ ..._ ------------------ - ---------- - ... . ------....--•-----•------._...-----......._..-------.._..------.------. -------------------------------------...-....... ....- -- ---.--- .. i final Inspection by:-. ----- --------------------- • -- ------------ ----- - ------------------- -- - Date. - EH 13 24 SAN JOAQUIN LOCAL HEALTH DISTRICT Fps 21Icy&/76 3M.-