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FOR OFFICE USE: FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit ---------------------- --------- ----"----------------- (Complete in Triplicate) Date Issued ,'� GZ�'/"J __-- This Permit Expires 1 Year From Date Issued 1 A lication is hereby made to the; anlJoaquin Loca� Health Dtstrict,for ajpermit to construct and install the work herein described. This application is made in complioncelwith County,Ordinanci to 549 and existing Rules and Regulations: rTM --- CENSUS TRACT._ JOB ADDRESS/LOCATIO ► - --- "f- /�8 ----- --------------------------------------- -------------- Owner'sPh , L 1 i _ a Name.___...'------ --- I € .� r �fa �� -_. C—City. K -- .. ..... ZIP Address.. - ti ,� � - .��1.3 C.C '_ = License # Contractors Name._ -=i j'• - i =� ; X14 1 Installation will. serve: , esidence-. :Apartment House ❑ Com ❑ Trailer C'OUrty❑ gR 7 1.Motel`❑ '.Othier--- ] _ t j /_/2- ------ - -- I __` 3� --_Garbage Grrnder_. ,; Lot'Size___ + Number,of living units, - - ;� J ---------- ---------------------- -,--Private ❑ Water Suppll .Public System norrie_-.----' . Chale r o ii to a depth of 3 feet: Sfncll ] !'Silt❑ jClay F-1 Peat [} Sandy Loam ❑ Clay Loam # `� Hardpan ❑ Adob �F II Material.".-_:_ If yes,;type1 - ° (Plot plan, showing size of lot, location of system:in relation wells, buildings,Ye_ 1cc. must be pladed on reverse side.) s �1'public sewer.is'available within 200 feet,] 1 P P ------Liquid Depth.-------:----------------k NEW INSTALLAT10Ni [No,.septic(tank or seepage it ermitte.yi PACKAGE TREATMENT [ ] SEPTIC TANK [ ] 1 Size__ f --- - { i1�amrial ----- capNo. Compartments acity. ` -----.--Type - - --- --------------------- ------------ sf . t I I ----- Distance :td'nearest: W,+ II ------ -------- -Foundation I-- -- - Prop: Li e-- -- Line Ii ` -------- :Length "Tota Len tht-- --- - ---- - i 4- lrie `= g LEACHING LINE_ [�J . ., k_. Lines1 } Na.,�of _____ of each • _` ' .. .- �'Depth Filter Material_------------ } 'ox..�---------T a Filter Materials--------,-- -�- --_�. . 'D' B . YP. . -•--- � � I I Distane fio riearest: Well's.__. -Fouridation_ ---------------------- ----------------- c ---Property Line -__-____ P:k ' ock De th Diameter.: " --.-----Number. --- -- SEEPAGE PIT [ l P --`- -- _ - R • ')led s o El t Water Table-Depth �------------- -Rock Size------ = r t P ; i i z Distance to ne arest: Well._--- :_d-----------,. P : ----- Date: __ - Prop. Line � 1 ---�: - -Foundation REPAIR/ADDITION (Prev. Sanitation Permit-#_ "" - -------------------- ------------------ -------------------------- Septic Tank (Specify Requirements)---- Di ------------- sposal Field (Spe fy Re )i-- ------ ---- --------- ------------- � .�- ",-_ _-___mow/�4t �- __ - --------- ------- ------------ f w at __-___ - _ --------- -- - - - _ _ "____." ---._ 1____ _______________________ t ------------------------------------ : /--�-�-- (Draw exiling and requiredddifion.on reverse side) k + 1 hereby certify that'll have prepared this application 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 age1 is r signature certifies the following: - "I certify that in-the p ormance of'the'work'f or which this permit is issued, I shall not employ any person in such manner'as to become bje to/,Workman's Co pensati laws of California." Signed- ---------------------- igned , c. -._r.. -- --- ------- Title [If other than"owner] 1 I t FDEP T ENT USE ONLY - ----DATE.----- .-� .fy ---7- =-------------- APPLICATION ----------- APPLICATION ACCEPTED BY `_-.""--- - - /�------- --- -----------------=------------- - DIVlSION OF LAND NUMBER ---------------------- DATE --------�- __ __ ADDITlO L CO TS - fC� _� -77__ '�'` ` ti`Rea �' __.___ _v _ /t'1 -- --- - ------------------------------------------------------- :--- --------------- ---- J = Df ------ ----------------------------------------------------- - - -----�- --- Date -� �--- -- -- _ Final Inspection b -=-- ------ P Y' 8s 21677 REV. 7176 3M EH 13 24 SAN JOAQU LOCAL HEALTH DISTRICT