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FOR OFFICE USE: FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT 7fZ ----------------- ---- - ------ ------------ (Complete in Triplicate) Permit No......._.._..�.__.___._ 3------------------------------------------------------ -- __ _ ----------------- _ Date Issued..:... . .... ......... -._-. .________ _. .__.._._ ...._.__ This Permit Expires 1 Year From Date Issue D� 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/LOCATION...... ------ . ----------- --------- ---- ,,r�-------��-+[TLe��N CENSUS TRACT-------------------------�.__. Owner-'s Name----- G =_ L / on ---YTJP�- ---- -- -------- Address.. ''-.S �� 1 - .•"�_-- ---- -------- Cit �• /� = Zi - -----� ----- --- Y P------------------- ---- -toe's -_-Phone-------------- -------------=--- Contra . / License • Installdtion:,willserve:- Residence ❑!. Apartment House ❑ Commercial ❑" 'Trailer Court ❑ t q Motel ❑- Other = t f Number of living un"its ---- .____.-._ Garbage Grinder-._ .Lot°Size.-.---:--------------- - - -------------------------- a - ---- ----- --- - ] ---------- Water 5u I t ��ublic S stem and-name__________ _________ _ ._.._ a otrl er o .bedrooms PP YNY ---------------- ---------------- Private ❑ Hardpan )Adobe, Fill M Character of S. a.depth of 3 feet: '..._Sand ❑ Srlt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ - € p ❑ � ❑ `'# aterial---1-•------If yes, type----- --------------------------- (Plot plan, showing size -of lat, locati.cirlof system in relation to welYls"!buildings, etc. must be placed on reverse side.[ NEW INSTALLATION: _-ffN054s'eptic tank or seepage pit permitted if public sewer is available withiri 200 feet,] PACKAGE TREATMENT J ] SEPTIC TANK [':] "« _• Size------------,-`------------- _ .. '-------------------Liquid Depth.. �� a�,• �' opacity -�TYPe-----= - --_...Material-------=--`---- ------ ;_No: Compartments ----- ( _ S `�... Distance to nearest: Well_-----------------------------------------'Foundation--------------------------Prop. Line----------------.------'___r LEACHING LINE, ['] No. of Lines-_-__'----------------------Length of each line-----------------.------------Tota l Length.__._------------_-----_-------_-- 1ClcST//I� Box Type Filter Material Depth Filter Material.-J ,---------- ,Distance•to nearest: Well..---------------------------Foundation-----------------------------Property Line-------------------- --____----- SEEPAGE PIT :[ ] Depth----------------D;iameter--------.--- -------Number------------------------ _______ Rock Filled Yes ❑ No ❑ I Water Table Depth. Rack Size= ------------ F Distance to nearest: Well.•........ .... _ --- Foundation--------- -----=---------Prop. Line ----------------- ----'- REPAIR/ADDITION (Prev. Sanitation Perrnit#-------------------------------------- --------------Date--------------------- --------------------- Septic -----Septic Tank (Specify Requirements)------ ---------------------------- ---------------- - = = 7,0 - --------------- --- - -------------'' 9 Ov Dis�posol Field(Specify Re qu' ements)------ _7 0 ---------------/- ---------------------------------- - ------ e - / ^�P�---- : ��--. -- --. --- -------------- ---------- = -.. C� d� -- --------------------------------------- -----=--------------------=------- --- ---------------=---------------------------=---------------------/-q--7b--z • -------- --------�---- ----- -- --- ------- ------i I �G1� t 2/y4,Draw existing'and required addition on reverse side) I hereby certify-thatl have prepared this application and•that the"work will -be done �in accordanee with San• Joaquin County Ordinances, State Laws; and Rules-and Regulations .of the Sari 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 becomes bj�A to Workm s ompensation laws of California." Signed- ---------•------------------------------- By ----- ------ - -BY =----------------- -- ----------- :_Title -------------,--------------------------------------- ---- .. .. .-. . ._ ._. - � . .I - --- - fIf other than owner) s OR:DEPARTMENT USE ONLY+ APPLICATION ACCEPTED BY-- DATE - ---- DIVISION OF LAND NUMBER.----------------------- - _ :_DATE . - ---,. -- ----- ADDITIONAL COMMENTS ---------------- ------------- ------------------------ - --------------------------------------- - ------ ----- ------, -------------------------------- --------------------=---------------- ------ --------------------------------------------------------------- -------------------- ------- -- ----- -- ----- ------------ I -^ q �f p Y �/U = --.,,r. _., _ --------------Date---- y- � �- Final Inspection b K- ,.. EH 13 24 1 h 7 REV. 7176 3M ,�'y,�:,....-��•-�- SAN JOA I�CA�HE,4'LTI�s,,DIST�ICT F&