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FOR OFFICE USE: FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT jPermit -- [Complete in Triplicate} - ----------------- -------- .................... ..... S fid' 7� Date Issued.......-----•..----- ......................................................... This Permit Expires 1 Year From Date Issued 1. 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: p of JOB ADDRESS/LOCATION.....P7-�- ".-Q .-- .._....... ...�P.r-�t� �/ra I d 1.L— CENSUS TRACT.. :�........ Owner's Name--- ....... - ------- -------ef. . ........ --------..... Phone ,- .. ......... Address............................................ ------, -----------.....................--- ....City------------------ ................... -.:.Zip------_...------ Contractor's Name._ :.......... License #. -7;- 3.y Phone.WG_ .g/ Installation will serve: Residence ❑ Apartment House ❑ Commercial D' Trailer Court ❑ Motel ❑ Other---- ---------------------------------------- Number ------------------- ---- -Number of living units:..... .....Number of bedrooms.------- - Garbage Grinder---.-------Lot Size.......:'.:.-..- ............... --------- .... -� i Water Supply: Public System and name------- --------------- �.r. . -....-------- ,---- --Private S� Character of soil to a depth of 3 feet: Sand E] Silt ElClay ❑ Peat [:1Sandy Loam 7,, Clay Loam ❑ o �. Hardpan E] Adobe Yes, type...Fill Material.- __.. ....1f ..... .... . .. .. � (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.), cls NEW INSTALLATION: (No septic tank or seepagepit permitted if public sewer is available within 200 feet,) • . ..- Liquid Depth.--- -------- -PACKAGE TREATMENT SEPTIC TANK Size.../U....._ - Capacity. j.---TYpe_ Material--- No. --- Compartments_.......::2....-------�---....... i -- . --- ---------Foundation----- . --.. ..... Prop. Line •...1.10 -ZDistance to nearest: Well... -..�'�- - _ LEACHING LINE No. cif'Lines .. ..........3---........Length of each line.-...--...--? ------------- Total Length . ,5----------------------- 'DBox............Type Filter Material.f° °�1`ac Depth.Filter Material........1$ ............ •------ --------- - Distance,to nearest: Well_�'.. Q..f..........Foundation-------- ----------------PropertyLine--•-•- ............. f r SEEPAGE PIT [ Depth-- F Depth --- Number........3— ------------------ Rock Filled Yes� No ❑rt •� - --Diameter---.c�� Water Table p �0....-- ----------=--------Rock Size ...�.. �?.�� ..... / Distance to nearest: Well.---.- ........Foundation---- Prop. Line------ ---------------- REPAIR/ADDITION (Prev. Sanitation Permit#-----_--------------------- -- -------------Date . ------ ) Septic Tank (Specify Requirements)---..-.-- ---------- ------ ----- ._ - .. ....-. { Disposal Field (Specify Requirements)......_._..----------- ` •---------------- i I „, ----- •---- -------------------------------- . ....--------------- _ ---------------------------------- _r-a w ----------- raw existing and required addition on reverse side) I hereby certify that I have prepared this application and that the work will Ve .done in accordance with San Joaquin Coun , Ordinances, State .Laws, and Rules and Regulations of the Sail Jbaquin Local Health District; Horne 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 becomeas . t t W kman's- Compensation 'laws of California." Signed.. 4. 1... ./L0. ` Owner 4 r Title.---- ------------------------ ----- BY----. .- - --... .- - -- JJ (kf other than owner) k FOR DEPARTMENT,USE ONLY APPLICATION ACCEPTED BY --.....�'�'� ....... .... _DATE ....._ _ .. ..... .--.-- DIVISION OF,.LAN.D-NUMBER... ......:..... .......-----------------/- DATE. _._. . ... ADDITIONAL COMMENTS.. .--... --- -------- ----------- ----------------- ----- --- ............ -------- . ...... ,.. .._ l _ ................... --- .............. ----•---------------------------- ------ .-•----- .....----- Date..._.. - Final Inspection by:._ --�... . - --- - - - - ------ EH 13 24 SAN JOAQUIN LOCAL.HEALTH DISTRICT �Fas zian aev. ��re 3M