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I FOR OFFICE USE: / FOR OFFICE USE: ! j/ APPLICATION FOR SANITATION PERMIT -�- - ----------------------------------- ' -_._........- .. 7 D -------------------------------- ------- ----- )Complete in Triplicate) Permit No.�f'TK.�- f ......_ Date lssued.ffl..1..-.----- ............................. ........................... 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 Ordinanc o 549 and existing Rules.and Regulations: JOB ADDRESS/LOCATION...//P_- _.--`�..�� ...........................` ' CENSUS TRACT.-..-------------- -- Owner's Name.---._..... ---Phone---'1.�_��-._3 'S� -- -- -- ...-- - Address_.. Q City. ZkP---=---- ._.: Contractor's Name......- Q�C. .�...:-�C- -� License #__a� �f-....Phone-.. r_ .- Installation will serve: Residence [Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel Other Number of livingunits:..... ..........Number of bedroo❑ms_----... - Gab • / � rbage Grinder------------Lot Size..-.��-.7 ------- - -------- --------------- ---- -- Water Supply: Public System and name.............. `_:.' r � _ Private' �4 ----------•. ..... .----- --,.--- =•-•---------------•---•-•-----------------... ------- Character of soil to a depth of 3 feet: Sand ❑ Silt❑ Clay.❑ Peat ❑ _S ndy Loam Clay Loam ❑ Hardpan ❑ Adobe'❑ Fill-Material" " -.If yes,type.----1-7................ (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,) PACKAGE TREATMENT -- [ � SEPTIC TANK '= Size.-..�--�,�'C_.5�-- -- - ---------------Liquid Depth.----�-�----------�-- --'"' Capacity-tRO-P-----Type -----`- + - --`-.Mate-riaL. 01 ' ..-__No. Compartments.-----: ---------------------,J Distance to nearest: Well-_.___��_-.....:_.................foundation_._��.-... -. _ Prop. Line--�`-......`.''�...._-_.�: LEACHING LINE No. of Lines.......S.............. g y g f .-.Len Length of each line,"/e. �.�U-_. Total Length .__w�.4..... ................. 'D' Box.-..✓Type Filter Material.S'-6)G .Depth Filter Material-:.. _�-.------ ------------- Distance to nearest: Well....-��.-- --- -- -- Foundation_- Z.S-----------------Property Line----2�_-- �-- SEEPAGE PIT [} Depth...o25.!...-Diameter.--3 ...........Number-------- -_---.-- -•--•- Rock Filled Yes No ❑ Water Table.Depth.---- Q- ----------------- Rack Size c -�?�.3-.._...` :_.... Distance to nearest: Well_jA0._Q------- ...................Foundation-- .........-.Prop, Line.....S.. .._ .--- REPAIR/ADDITION Prev. Sanitation Permit#---------------I ---- Date------------------------------ -------- Septic Tank (Specify Requirements)--------- ------ ----------...... ---------- r -- ---------------------• -- ----....... ------------------------------------ - f Disposal Field [Specify Requirementsl..............:... -_-- ................................ ......----................................. - -------------- -------------------- -------_---------- --------------------------•-••--•-•••----------- - (Draw existing and required addition on reverse side) u. I hereby certify that I have prepared this applications 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: "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 becoin sMe t to War man's Compensation laws of California." Signed----- . -- t.. ..: Owner ------ � - '�/ _- -.... Title---------- ,_f----------- BY- - --- ------------ ------ , (If other than owner) FCA DEPAVMVJT UV ONLY APPLICATION ACCEPTED BY------ ..........DATE.....------ _7 ".. DIVISION OF LAND NUMBER----------- -- -_.--- - -------- ... .-_-._-- DATE.................. ----- -------------- ADDITIONAL COMMENTS-..-- .[�'� .... .. . ........ - ------- - :----------------------------------------------------- ----- ------------------ --- --- ----------- - ----. ------------------ .------ --- . .. - ---------------------------- -------------- - -------- ------------/� ... r Final•Inspection by-- f: -------------- -- --Date.--- EH 13 2A SAN JOAQUIN LOCAL HEALTH DISTRICT rss 21677 aev. Ana 3M