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FOR OFFICE USE., APPLICATION FOR SANITATION PERMIT Permit No: ��--�-�--�-� ------------- (Complete in Triplicate) ` --------------- -------------------------- Z L ---------- --- ---_--- p Date ),sued -�- This Permit Expires 1 Year From Date issued ------------�p-------------------------=--------- --- rict ct and e work A lication is hereby made to the San Joaquin wiLocal Hh Counealth DtytOrd Warn a permit and existing RulestalndhRegulationsfe�n described. This application is made in compliance _ ----------------- --- CENSUS TRACT --•----------------------- JOB ADDRESS/LOCATION -----_--- --�---�- -- -- - ----- ----- - --�-------- ------------Phone _�b�---�------ -- ------------ --------- f W_' ------ Owner's Name ----------`-----------' Address ----------------------------- e # ------ Phone ----- - - - --- ---License -- -- - --- Contractor's Name ---------------- --- --- ------- -- - Installation will serve: Residence `1''[Apartment House-F-1Commercial ❑Trailer Court .ti❑ Motel ❑ Other ------- --------------------------------- { l/-Q---------------- Z�Garbage Grinder -.____--._- Lot Size -�-�_-___-- -- - - Number of living units:.-- /----- Number of bedrooms ----_--__- r Private ❑ Water Supply: Public System and name �--------------------- --------- Clay Loam Silt❑ , Clay ❑ peat❑f Sandy Loam ❑ El Character of soil to a depth of 3 feet: Sand ❑ mss,. !` Hardpan ❑ Adobe Fi11 Materiabuildings, � l ----f.- y-- if es,type ------------------ o ells, etcmu st be+placed on reverse side.) (Plot plan, showing size of lot, location of system in relatio�nµtailable within 200 feet,} i NEW INSTALLATION:. (No septic tank;or seepage pit permitted-1f-public sewer is av 5;ze -- "=— -= -- -- Liquid Depth ----------- -------------- PACKAGE TREATMENT [ ] SEPTIC TANK'[ ] ,,,ti G Ca acit TYPe -----------------------.Materigl ---- No. Compartments ---.-------- --Foundation ---------------------- Prop' y Distance to nearest: Well ----------------- ---` Line --- •--------- - r ------ LEACHING LINE [ ] No, of Lines ----- - - ------- Length 6f each line-------------------- Total Length Depth Filter Material ---------- -------•---------- } 'D' Box ------------iTYPe Filter Material ------------- P ( f ------ Foundation ------------------------ Property Line --------••-------------- Distance to nearest:sWel _--------------- t SEEPAGE PIT [ ] Depth -------------- Diameter ---------------- Number ---------------------------- Rock Filled Yes (] No ❑ I - k ----Rock Size -------------------------- Water Table Depth =' > =° = '-------- Pro ine ---- -----Foundation ------ --- p. : L Distance to nearest: Well _- + ` REPAIR/ADDITION(Prev. Sanitation Perm' _ Date ---------------------------------- "" --------------------------- -------Septic Tank (Specify Requirements) ----,------- y ------------------------- Disposal Field (Specify, Requirements} --__ --------� ti_ _ 0---------------------------- -7-- - ------- _-� �� +r.-{ 1 ----- ---- -- - ------- 14 --- `-- S } (. ------------------'---------------------- (Draw existing and required addition on reverse sirk will be e) ne in I hereby certify that I have prepared this application Regulations and that the wo the San Joaquin Local sed D stratnwith Home or I cen- County Ord inances,# State Laws, and Rules and sed agents signature certifies the following: "1 certify than in the performance of the work for which this permit is issued, I shall not employ any person in such manner as to become subject to Workman's Compensation laws of California." I _--- ----- _.- -�'�Owner �. r.. Signed -------------------------- -------- -- --------- -- ----------------------- � --- -------- -------- --------- - Title ----- ------ -- ---- ------ ------ ------- - -------------------- -------- --- -- - ----- (If of an owner) FOR DEPARTMENT USE ONLY 1 ,mss_• DATE -------------•------------------------ 1 APPLICATION ACCEPTED BY --- - 8 V d / DATE __.. BUILDING PERMIT ISSUED ---------------------------------------- - ADDE710NAL COMMENTS - �_ _ - �-- --- ------------I----- ---------------- -------- ---- -- --- 7 - f " "" - —------ - - _ - - -- Date } ---__ cam- - Final inspection bY� --- ---- - -- ---- -- ---r%- _ --�- .�-------- ------ - SAN JOAQUI LOCAL HEALTH DISTRICT L F H 9 1Rev. 5M