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i FOR OFFICE USE: FOR OFFICE USE: + APPLICATION FOR SANITATION PERMIT12 91 ---------------------------- ------------ ---------- Permit No. - ----------- -- �(_'$- {Complete in Triplicate) , -- ------------ ---------- b -�L G ?? Date Issue _______________ __ , --------- 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 an existing Rules and Regulations:. _ --•°"sem ES S/LO- C AT•O: N � I�t 2d ------ --- -- - CENSUS TRACT)° -------------- JOB �. - JOB ADDR _ - Phone.--------- #r i .r � - _. ..,Owner's Name - -- --------- -- ----------- .,.. . Zip - Address -.--- ----- '------=---- --------City--- -- - --------------- -------- -- - ll------------ -- �f Contractor's Name__: ---.. - License #-i8 - ---Phone.. _.._ -- Installation will serve: n Residence {� Apartment House ❑ Commercial ❑ .Trailer Court ❑ 4 1 __---- Motel Other-Garbage Grinder__ ` Nurriber of..bedroom s_1.� _------ -- ot.Size--=---------- ----- ---=---- 1 ' Number of living units------------------ L .. Water Supply: Public System"and name .. ' ---------- ==--- ----------------------- ------ ----- ------- F.- Private i e=❑ rt Character of soil to a depth of 3 feet-,. Sand :Silt Clay Peat ❑ tyPandy Loam ❑ C1ay Loam ❑ ❑ ❑ Y.❑ �. p - k Hardpan Adobe-❑ Fill Material--_-------.-If yes, e l (Plot plan, showing size of lot, location of system in relation to'wells, buildings, etc. must be-placed on reverse side.) k NEW INSTALLATION:- -.(No septic tank`or 7eeage pit permitted if public sewer is available within 200 feet,] i -- '"Size" '_�;��` - ---------------of--- Liquid Depth.._� � , PACKAGE TREATMENT [ ] SEPTIC TANK �r R Capacity Type-. Materialt Compartments = - I s ' dot-ion - �__ -- =- ---- - -------. -s---. .'Distance to nearest: .Well.:.. `. __�__ _ . _FouProp Line l _ �, �`' is f S / "� g LEACHING LINE: . [ .]._-. 1V a. of.Lines___._ r ., . --___'.-' .Length- f each line _- � -Total L / tfi z -.�------- i ---- I • --�-. /Q D' Box _/__ T p e Filter Material. `t----Depth Filter Material -.,K/f--------------------- - --- --- ----------- -------------------- { Distance to nearest: Well- i �-`- - Foun at' n-._--` ._ _ .Pr'operty Line 'sem- - �-• �,.;; de th-4°'--i�- --Diameter.-._--- Number__ -- - Roc Filled Y N SEEPAGE P1T [ p .� - },' - + _ . - . ..., � / k led e No❑ _. , ,; y / Water Table ..Depth----- ----=-----� ----�-�'',-f-`-- �-: - =-----Rock Si�e�--�' �'6-1-�--- -----� .J - ,��, j --Foundation_ Prop, Line--- _-' Distance to nearest: 1Ne11. ..___;_ _ Cl _- -_-- `�'� '� ' - REPAIR/ADDITION (Prev. Sanitation Permit#--'--------------= ---✓---,-------.---------------Date-_:': __`-- _------- 1 u a X - `�` ---- --------------- --------- -- -- Septic Tank [Specify Requirements)___-_�_,- =�"`"- k....�+ .� r Disposal Field (Specify Requirements]- ----� _ ------- �. ---- ------- -------- ------- I----. - ---- ------- - -- ---- . ------------------ --- ---- --- g = q-=` -- i J(Draw ezistin and re uired addition-on reverse side) 4 I hereby certify that I have prepared this and that the work will be done in accordance with San Joaquin County Ordinances, 'State Laws, and Rules and Regulations of the in Joaquin Local Health Di}tact. Home owner or. licensed agents signature certifies the following: h f "I certify that in the performance of the'work for which this permit`is issued,,—i shell.nofi a ploy any person in such :+fanner as to become subject to. Workman's Com ensation laws. of ifornia." , [ _ ` - Signed----.--;---------- ---- ------------- -- ----- ---_ - AV w..._... �- --- -- - - itle 1 (If other n owner} i . FOR DEPAR ENT USE ONLY -DATE ------------ APPLICATION ACCEPTED B --- DIVISION OF LAND NUMBER.-----__. - DATE __ ADDITIONAL COMMENTS------------------ --- -------- r - ------- -- k ______________________________.______________.---_.-----__-.---_.-_.---_------..--._..----_---_--_-_--.-- h _ ___________ ________________ ___________ ________________________ ___ _______________________________-------- --- ____ _-.--_--___ --------------- 2 - D to - Final Ins ection b =ra_ - a EH 13 24 SAN JO QUIN LOCAL HEALTH DISTRICT res 2ie�� Rev. �I�6 3M