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y FOR OFFICE USE-- FOR SE:FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT �j Permit No.. _ ..... •- .�.!....... W -..------ ------------ -------------- - --•------ (Complete in Triplicate} z _ •..----- Date Issued.. y-� ...... 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/LOC ON171 .!--.-D....-----�'"'-� ----- - ---------------- CENSUS TRACT.. , ---- ---.Phone f� ._.... ----•--...------- �-- --------------------- Owner's Name.... �.. ......[.r ...... -----•------------- ------- ��....._.. / ....��e .--- ... ... .Cir C ��l _-Zip Address------ ----- --- Y�----- ------q:----- --_ � .. . � .� oo u}. ..... License #Z.V.DOd-C .Phone_ Contractor's Name--------------��..- - -�� -d. - -� � � � • Installation will serve: Residence�j'"] Apartment House ❑ Commercial ❑ Trailer Court.0 Motel ❑ Other....... ........ ; Number of living units:......--------Number of bedrooms. Garbage Grinder"_.---- --Lot Size............ -- . -. S - ----.Private ❑ Water Supply: Public System and name_.- .-� - - � Q - ..-.. Character of soil to a depth of 3 feet: Sand ❑ Silt❑ Clay ❑ Peat ❑ Sandy Loam ❑ Clay Loam ❑ Hardpan ❑ Adobe Fill Material- If yes, type----- ------------------ (Plot -- -(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,] i PACKAGE TREATMENT [ ] SEPTIC TANK [ ] Size -----------------------------------------•-- - - --..Liquid Depth._-_'----------------� ....No. compartments-- •--=--•--•---------- --------- I Capacity..... --------,Type............__...... Material------- -------- • Distance to nearest: Well.:................""----.---.---- - ..-....Foundation------- -- Prop. Line - LEACHING LINE [ ] No, of Lines..--_--------..............Length of each line-------------------------- 'D' ------------------------ - .Tota! Length . .-------•- ... ..... ........ .... I - 'D' Box._..........Type Filter Material------ - ----- ---Depth Filter Materia ------...----------.----- - ----.----•--- --- .--- ------- .....Property Line"------------- ---- Distance to nearest: Well...----.•------------ ---- Foundation.------------------- - P ..Number--------------------- ---------- Rock Filled Yes ❑ No [] 'f SEEPAGE PIT E 1 Depth.-----.-- �-----Diameter-----------------" - . I Water Table Depth .... -Rock Size------ ---I— . '--------..._ Distance to nearest: Well-------------- ---"" ---------- ---------Foundation ....... Line----- --- -- ---� -- --... �AD (Prev. SanitationPermit#.. := .........Date ---------- y Requirements)_ ]nts A4 is ..._ 0 G4� . .� -:.�- �/h1 1 i Disppsal Field (Specify Requirements) •- (Draw existing and required addition on reverse s d e I 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: formance of the work for which this permit i5 issued, I shall not employ any person in such manner as "1 certify that in the per to become subject to Workman's Compensation laws of California." Signed.. ---------------- Owner Title----.. (If other than owner) FOR DEPARTMENT USE ONLY DATE APPLICATION ACCEPTED BY" -------- --------------------- t - DIVISION OF LAND NUMBE --- -- . . DATE _;: 'I iTlONAL COMMENTS i.....' : i ADD :. ----- _ ':. ::. _ �.� = A_ � w� .:: .a- �_� -- ! ::..... i _ ---..D&t�:.. Final Inspection by --.-"- Fas . 7/7h,3M SAN JOAQUIN LOCAL HEALTH DISTRICT