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FOR OFFICE USE: . - w FOR OFFICE USI=: r APPLICATION FOR SANITATION PERMIT --------- ---------------------- -- ------------- Permit,No._ �------------ ,� lIComplefe in Triplicate) 1�_ zF » ' "� "' � '� `� 101 Date•Issued__��-----._-_-- 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/'LO TION_: �I- tl CEN TR ----- Owner's Name. .. __.__ ._ Q Phone....... --- ---- - ------- .._ to �j ' Address._. - L"-- . = City- -4 -------=----Zip------------- ---- ----------- Contractor's --- - - Contractor's Name [�� ------- a-� �r - -- -.s _ /s L nse #_a f4S' _ on �� `�Cl4__ ice r Ph e Installation will serve: Residence Ad partment House F-Commercial [71 .Trailer Court ❑ i r. € Motel-E- •Other---" _ i ., ;,_4 i Z" Nu Nu�ber of,living.units_ _________----------------Number of_bedrooms{. .Garbage Grinder Lot Size._.__-______ € ---------------- W ater --- -- ----Water Supply: P blit System and-narrie------------------- ---- = - -_--Private Hardpan Adobe' ,- FilElMaterial.".,._. ❑ ------------------------o - Character of soil to a depth of 3 feet: • Sand •Silt Clay Peat Sandy Loam ❑ Clay Loam ❑ p ❑ Q� If yes, tYPe----- ----`------------ -- t _ (Plot plan, showing size of lot, location of system in relation to'.wells, buildings,'etc. must be placed on reverse side.) NEW INSTALLATION: .",`_...."ge ' ._p'e -_"" _ "" .(No septic tank or seepage pit permitted if public—sewer is available within 200 feet,] PACKAGE TREATMENT [ ] SEPTIC TANK [ ize __ __________:___________Liquid Depth erCapacity� Type _ Matial : No Compartments_____________-----' Distance;to nearest: Well._.._ _;; -------- Fou dation_;/_�---_-------------Prop.-LLine_. P_! LEACHING LINE - �_ --------------- Length Len th of each line.. d'_ Q_- __.Total Len th..__.,< ________________________ [ NO. of Lines.--- ----.-- - -9 -- - - 9 � YP _ ;.q�.Depth Filler Material----Ze----------------------------------- --------------- - - ------ - t D' Box__.__.___:__T a Filter Material'__.__._. ".__:_ .Foundation .. t , T � ��r, re ��r�^�-- p -ty iine--�-- ------ ----- - [ _ r Distance to nearest: W.ell �/". Foundation-__: Q_._:=_____'___.Pro er . SEEPAGE PIT [ DepthDiameteNumber :__ ____ Rock Filled Yes No❑ Water TableDept ------- ----------------- Rock Size = ' Distance.to nearest: We11' + --------------___"-_:'_-_-'__Foundation__ _..____-,_ Prop, Line._ REPAIR/ADDITION (Prev. Sanitation,Permit#__t.___1_ ___: ------- ----------------------------Date____.____.._____ ---- Septic Tank (Specify Requirementsf__._.-_____.:_s.__.____ ____ _____________ } ------------------------- --- - ------------ ------------------------ -- ------- ------- . Disposal Field(Specify Requirements[ ---- -- ---------- ------------------------------------------------:---------- --------------------- r -------------------------------- ---------------------------- - 1 ---- -------------------------------- ----------------------- -- ---------------------------------. .-- --------7- ------------------------------------------- ---- -------- ------ --- ---- ------ ------ - ---=------=- ------------------- --------------------------------------------------- (Draw existing and required addition on reverse side] 1 h reby certify that I have-preperecl 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: • w "I certify that in the performance of'the work for which this permit is issued, I shall not employ any person in such 'manner as to becom ect to Work sensation laws of California." .. Signed------- -- --�-- -- - -Owner ._ _ BY.` 1- �G� Title ' -- ---------------- (If other than FOR DEPARTMENT USE ONLY 4 APPLICATION ACCEPTED BY_ - ------ --- - --------- - ----==------------------------DATE.- r� ' _�`-_.T.�----- :--- € DIVISION OF LAND NUMBER-------------------------------- DATE ' ADDITIONAL COMMENTS - =------------------------------------------------------- - -------- --- -------------------------------------------------- -- ---------------------------------------------------= ---------------------------------------- ------- - -- »Fina!•Inspection.b Date._ � _�_ --------- p w_ � -------------------------------' -- --------- EH 13 24 SAN JOA4l�IN LOCAL HEALTH DISTRICT F&S 21677 REV.7/76 3M