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FOR OFFICE USE: FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT -7�- 3 3.._ Permit No.---- ---- ---- --------------------------------- ------------ . -- ---- --' -- ' -------- (Complete in Triplicate) /-_2/- 7¢ Date Issue __---. This Permit Expires 1 Year From Date Issued - ----- ----- --- " �. ---------------' ,. ' n is hereby made to the San Joaquin Local Health District fora permit to+construct.and instal! the work herein described. Applicano "" application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: This app CENS � ------------ TRACT,-._ --------- - ' JOB ADDRESS/LOCATION- "---- -- - - ----- one - - ---------------------- ----- - _ ' _ __ ----- ----�� -- - ---- Zip ------------------ ner's Name-- --- ity --- - Ci Address--' -- - - - - Phone_.--- - - -- - -' k " "License # u Contractor's Name---------- "--- '-- Commercial L] Trailer Court El esience ; lnstalVation will serve: ❑ Apartment Hous ❑ - #' Motel ❑ Other: ,' ' ` / k arbage Grinder-----------Lot Size-----1---- Number of living units:._".. - -----"Number of bedrooms'- - Private ❑ ------------- Loom- ' i Water Supply: Public System and name___----- ---- Pe'at; .��Sa dY Loam ❑. SCl,1,Lo [I Character of soil to a depth of 3 feet: Sand ❑ 'Silt❑ Clay ❑ ,� �^ -A e.---- Hardpan ❑ Adobe ❑ Fill Material ._ .. -.--if yes, type ,_. t i showing size of lot, location of system in relation to wells, buildings, n rev er is avabableawi hced on 200 feet]arse de}} O a (Plot plan, s g -%L, permitted if public sew L No'se tic tank or seepage pit p . NEW INSTALLATION:` ( p. Liquid-.Depth__------------------- -Q S LL Mater! r«� t } TY P SEPTC°7ANK�'-1:Y� ue---- ----'--- ; PACKAGE TREATMENT"L'j " _ } --.I t Capacity---- =-----------= e-=------- 'al---` --=- =--' =--- --- Compar#ments:-•- ---=------------------------- No.! tante to Foundation -- .___s- ',.Prop. Lin ;p nearest: WelV_'.-- " - -- -- -- - - ------ --- - - 1 ----------- Distance l ' h. I :.- -- .Length of each Tota .Lengt LEACHING LINE t�1.,,. .No. of.Lines - -_ - -- i D' Box-__---"1 --Type Filter Material-------- ----- Depth Filter Material- - ------- - S A ine- .. �^ � �i a o er � L� - y p } ❑ - ., - Foundat'i nom__--- --� � . r Distance,to nearest: Well -------------------------- k Fi ";Yes N o. . ------------ -- u ;..,... ` ---Number---} SEEPS PIT f l' ; Depth._" 6- Diameter_: �� . --_- ----- Rock Size t Water Table Depth---=------ ' - .Prop. Line I Distance to nearest: Well.. Foun anon._.."_"--- A _ . ._: ---.Date---- ------- ------ =- ........ 1 - REPAIR/ADDITION (Prey.Sanitation Permit#__:_---- = -= ' _ ----------- -------------------- -_---_- "________________ ecif Requirements) -.. _- =_ = = = = ------------ Septic Tank (Specify '- --------------- ------=' k ._ ------------- ------ __ __ __.__...___ Disposal Field (Specify Requirements)----- _ --------------------- ------------- -----------------------------------: : F --------- --- --------- --------------- ------------ - -------- ---- - , --------------------- ------------------ ----------------------------------- -- # ----�-------------"------:".- .. - I - - (Draw existing and required addition on reverse side} s • lication and that the Work will be done in accordance-with San Joaquin County I hereby certify that'l have prepcired ibis app t Ordinances, State Laws, and Rules and Regulations of,the San Joaquin Local Health District. Home Owner or licensed agents signature certifies the following: = shall not mPloy anY person in such manner as "I certify that in the performance of"the work for which this permit is issued, I e to become subject to Workman's Compensation laws of. California." i = Owner Signed ------------' --------- ------ - -'-- - _ --- -Title-------- -•--- --- = -- -- gY-l---- 1f o h t an owner) r FOR DEPARTMENT USE ONLY {" DAT APPLICATION ACCEPTED BY->_. .._ - - -.---- ' --DATE_.. --'-=------= ------------= ------ _ -- ---------------- 10DIVISN OF LAND NUMB -------------------- -- - --- --=--- ------ ------------------------------- ADDITIONAL COMMENTS_.. = c c -------------- -- ----- ............ ------------------------- _ ------------- .--------- . ---------------------------.------ -- - ------------------ - ---- ----• = :---Date_.. ' --_- - "--" F&5 21677 REV.7 Final Inspection by:_._ "-'------------ ----- ---- ---' --------- --�----- - - - "_- - --- �SAN JOAQUIN LOCAL HEALTH DISTRICT EH !3 24 _