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• FOR OFFICE USE: FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT 7 7- � • Permit No--- --- -- ------ -- . ;� �/J (Complete in Triplicate) 4 Date Issued._�d°�-7--�� --------=-------- II - _ This Permit Expires 1 Year From Date Issued - •-----------------------_5__" ------------ . Application is hereby made t I�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: PP --------- ` Q�Z� � CEN CT --------------------- JOB ---- --- --- ---. - •� � ---- -------- -- t SUS TRA - JOB ADDRESS/LOCATION. ----------- e j. Phone- --- ------------------ -------- - ------- Owner's Name- -- - ---------------�` "`�---- ---------------------- -- ------�----- :--- ---------------- -----------CiP Address"---------- .�'� S r city Z! ----------- -- -------- • - ` +-� ---- License # Phone_.- a Contractor's Name-_- - t '` •• �, installation+will serve: a` Residence ❑ . Apartment House.❑, Commer/ci lg ❑ Trailer Court ❑ Motel ❑ Other-- -Size l�"'"• 1 F Number of living units:----._/_-, umber of bedrooms ms-.--/.- Garbage Grindw------- ----Lot =----" /-'�- = - `----------------------------- ----------r e l _--Privat Water Supply: Public System hand name.-.--.;---:----- - -•---- ---------- -------------------- Character of soil to a depth of 3 feet: Sand ❑ Silt ❑ Clay ❑ ` Peat ❑ Sandy Loam ❑ Clay Loam ❑ i Hardpan W Adobe ❑ Fill Material_.---_.----If yes,type-------------- {Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. .must be placed on reverse side.) / P _ _". �.. NEW INSTALLATION: (No' septic tank or seepage pit permitted if public sewer !s al`able within 200 eet, — '' SEPTIC TANK [ Size_ ! - x- X -- ----= Liquid Depth."_ J PACKAGE TREATMENT [ 1 = I �`-�-------No. Compartments..-_�— --•--------------- --6 -r--- -- T e- Material , .. Cap cFty YP ; ) �--- i 0 F Distance to nearest: Wel 1...---"-:.--.--ar a- "---Foundation-_._----Z-�'�-�-- -Prop. Lin No: of Lines-_-__ -- ----.-----.Length of each lino--- Q" ------------Tota`l Length ---- - ---------------- 1.411) , ' LEACHING LINE I 1 _ 1 C: D' Box. Type Filter Material` Depth Filter Material---------------I------------------------------------------ ;, Distance to nearest: Well..--` '- --------Foundation__.----- -. - -----.Property Line--:____-S 2 - ' r.� �� Number = --_ „ Rock Filled Yess ❑ iDepth--- �SEEPAGE PIT � l � Water Table Depth________________-------------------- ____Rock Size X = b -----Foundation--------1_0--r-------.Prop. Line------- 'Distance fo nearest: Well__".___"-__�- '� IIS.- �- -:- -r. --------Date-'-._.. 1 REPAIR/ADDITION (Prev. Sdnitation_Permit s _ -- --------- ,A„ --------- Septic lank (Specify Requirements) --•---- -------- - ---- -- --------= -------------•-- -=----- ----------- ----•- -------- --------- r -------------------------------------------- ' I N Disposal Field (Specify Require ents).---.-- ------ -- ------- - - ��✓ -------- --- • --------------------- --------- --- ----------------- -------------- - ,-is ---- ---------- ------------------------------- -------- - -- - - ---------------------------------------=---------------------- (Draw existing and required addition on reverse side) I hereby certify that I have-prepared this application and that the work will beHealth District. Home owneance with d orJli licensed agenoaquin S Ordinances, State Laws, and Rules and Regulations of,the San Joaquin Local : signature certifies the following: person in such manner las "1 certify that in the performance ormance of the work for which this permit is issued, I shall not employ any to become subject to Wairkm Cyompensati Taws of California.". ' II _ = - Owned . Signed------- - ---------- -------- --- ---- le---- . ---- =- ----------------------------- By -------- --- (If other than owner) , - .FOR DEPARTMENT USE ONLY '- BY._- -- - ------- --- - ------DATE---------------------=---------- - ------ APPLICATION ACCEPTED ° ADDSTIOONOAL COMMENTS ER----------------------------------: ; - ------ DIVI F LAND -- - ----- ------DAT ----------------- ----- ----- ------- �- ------ ----------- ---------------------- ----------------------- ------------ ------- ------- j� ---------- -- --- - -- - ----- --- -- ___lJ J :_. --- - -- --------. -- ate. _ ,� - Final Inspection b --- - ----- ------------ - 5 2167 EH 13 24 �, SAN JO Q LOCAL EALTH DISTRICT f