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FOR OFFICE USE, APPLICATION FOR SANITATION PERMIT Permit No,. --------------- ----------------------- -------_i--- (Complete in Triplicate) I� -------- P ---------------------JYear From Date Issued Date Issued This Permit Expires 1 ------------------- Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein existing Rules and Regulations: descri&d. This application Js made in compliance with County Ordinance No. 549 and I ADDRESS/LOCAT —Iq -2- il�) -------------------------- JOB -- --- ------ -------- -----------------__-----CENSUS TRACT .1 -------- ___ -Phone------------------------------------- Owner's Name -- ------ City -------- ------------------------------------------- --------- --------- Addre's- ---------- - - -------- --- - - Contractor's Name ---- ------ - -------- ------7 ----- -- --------- License # Phone ------=----------- !11 Commercial ❑-E]Trailer Court '[1 Installation will serve: Resident Apartment Housefl Commerc MotelF1 Other ------------------------------------------- rooms __k4------Garbc!ge Grinder ------------ Lot Size -------- -------- NUM611'r of living units-------------- Number of bed Water, Supply: Public System and name --------------------------------------------------------------------------- --------------------------- Private I Loam -[!K CIO Loam.E) Character of soil to a depth of 3 feet Sand'El Silt El Clay ❑ Peat El Sandy L y I --------- I Hardpan [J Adobe F7l 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.) seepage pit permitted if public sewer is available within 200 feet,) NEW INSTALLATION: (No septic tank or seel: J I h 1 -4 4 _J( ---- ------ Liquid Depth PACAGE TREATMENT SEPTI TXNK No. Compartments -------------- --- Material 77T;pe&_�a- ci ty 'clation ----10--1--------- --------- C6pa I Drop. Line Distance to nearest: Well --77 Fobn Length :--- QPM-----•------- .10--t--------- Total -- LEACHIN_ LINE No. �f Lines --------14------------ L66'fh of each line 9 - J0 - - ------------------- `D' B6X -- Type"Filter Material 75 5---k-----_-Depth-------Depth Filter Material -----I�j---------- Ty i Line :_�_5----------------- ty Distance to nearest-. Well ---_..50---_-_------/ Foundation -----$_I�------------- Proper SEEPAGE PIT Depth -------- ----------- -Diameter ---------------- Number ---------------------------- Rock Filled Yes ❑ No 0 iRock Size ---------------------------- Water Table Depth ------------------------ ------------------- Distance to nearest-. Well -------------------------- -------------Foundation --------------- ---- Pr6p. Line ------------- -------- -- REPA.IR/ADDITION(Prev. Sanitation Permit ------------------------------------------- Date --------------------------------I I I .IIi .--------------------I------------ Septic Tank (Specify Requirements) --------------------------------------------------------------------------------------- --------- ---- ------- L/ Disposal Field (Specify Requirements) ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ------ ------------------------ ------------------------- ------- --------- ----------------- I---------------------------------------------------------------------------------------------------- ---------------------J---- - - - ------------------- --------- ------------------------- (Draw existing and required addition on reverse side) that the work will be done in accordance with Son Joaquin I here y certifythat I have prepared this application and t 1�. lotions of the San Joaquin Local Health District. Home owner or licen- sed Ordinances, State Laws, and Rules and Regulations II! sed agents signature certifies the following: i "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 411. ecome subject to Workman' ampensation laws of California." 11 Owner Signed ------------------ i - ---------------------- By -.11 C� I—1 -1---- ----d Title A (if other than owner) FOR DEPARTMENT USE ONLY ------------------ ------- DATE ----------------- -- --- --2 Y APPLICATION ACCEPTED BY ------7----------- ------------------------ --- ---DATE -------=1-------------------- -------------- BUII11DING PERMIT ISSUED ------------------------------------------------------------------ --------------------------------- ------------------------------ ADDITIONALCOMMENTS ------------------ ----------------------------------------------------------------------------------------------------------------------------------------------- -- -I ------------------------------------------------------- --- I IA 0, 111V ------- ---------------------------------------------------------------------------------------------------------------------------- - ----------------------------- ----- ---- -7-f-kaA,------- T I V ---- ------------------------ ---- 7--- ------------------- ----------------------------------------------------------------- ----- 7�4_ _ .Date -------------------------------------------- FinalInspection by; ------------ ----- -------------------------------- ---------------------------------- ---------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'6$ Rev. 5M ...