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- FOR OFFICE USE: -� - APPLICATION FOR SANITATION PERMIT FOR OFFICE USE: (Complete in Triplicate) Permit No._ S-_-Qa, --------------------------- ---------------- - ---------- ----- This Permit Expires 1 Year From Date Issued Date Issued_$_- ---,-.7e Application is hereby made to the San Joaquin Locpl Health'.District for a permit to construct and install the work'herein described, This application is made in compliance with County OrdinanckNo. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION- T 1 ----------- Owner's Name.:--- � US.TRAC --- - ---- ----- ----- .� ---------- ---- ------------ NS L - = �" Ph Address_ �_�� . - - -- --- -- ----- - I ---------- --- - -- city._, -------------------- C�tY Zip a Contractor's NameLicense-#-- _�_- ----- ---Phone------ 1 Installation swill serve: Residen a ❑= Apartment House.❑ :Cotrim rcial Trpiler Court ❑ ; Numbs. - -•; ..�.. w T. -Motel 0 -{.Other-._ . -- Number of living units:---------:__.__.Number-of bedrooms------------.Garbage Grinder___ ----- ------::-_------------------ Water Supply: Public System and.name '". ` •. d P Chir °-_. LcJl -- = --- ------------------------------- rivets�❑ I`fi Character of soil to a depth of 3 feet: I Sand ❑ Silt❑ Clay Peat Sand Loam [ _ Y � ❑' Y ❑ Clay Loam Hardpan ❑ `Adobe ❑'� Fill Material _If yes;es,-,type l ----- ¢ --- (Plot plan, showing `size of lot, location of system in relation to wells, buildings;etc. must be-placed on reverse side.) Y NEW INSTALLATION:— ,(No' septic tank or seepage-pit-permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT _,.. ,._AT K - Size ---�--- ----------- ` f--s- •--; h- -- - ----- - Liquiep CaPaeity_)" - TYP------ No.•Compartme.nts---- = ------------ j .: ` = Distance.to.nearest: Well_:.___.___,�.Q-�a '._ ..---:Foundation---___7 �. .Prop. Line.___. , ------------- LEACHING LINE. [ No. of Lines. ,J [ ------_-.Length of each := ;D Box -.Type Filter Material_._��_ Depth Filter ------------------------------------- Material. '____1g Distance to nearest: Well______:_0 0,_ -Foundation------- S _, -- -_.Property Line____ pp , Rock Filled `Yes f SEEPAGE PIT [ ] s Depth___�.d__Diameter_.___�.lr._:___Number_______________'_____E___-_�_ � � �-+�,. No ❑ Water Table Depth________ Rack Size__._�� -------------------- . = ---r------- Qistarice to Hearse#: Well-_- - ___Foundation___. ar -.Prop. Line.__-_- �- - -:�.,-, z REPAIR/ADDITION {Prev. Sanitation Permit#__°_____________------- _ ------__.Date - Septic Tank (Specify.Requirements)------------- ------------- ------------------ ----------------------------------------------------------------------- Di;poscil --------------=----- ------ -------------- Di;poscil Field (Specify Requirements):- ---------------- _---__----__, _ �, - ------------- ---------------------------- ----- ------------------------------- [ �r r ________________________________________________________________________________,---_--,-------__ _ __ =,(Draw existing and required-addition'on reverse side) I hereby certify that I 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 agents signature certifies the following: t , "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 become subject to Workman's C i nsation laws of California." Signed. -------------- - --. n -- CtW ar BY - ^° � = Title -- --- ------ - r - ( (if other than.owner) . k FOR DEPARTMENT USE ONLY I APPLICATION ACCEPTED Be-- '- `f' == -- DATE. 1. ... -------- -------------- DIVISION OF LANA NUMBER ----- ---- - ---------------- ----------- --------------------- ----DATE. ADDITIONAL COMMENTS = , ----------- --------------------------------- •- ---- ------ =--_=----- ' = -------------=-- --------------------------------------------------------------------- -- ---- ------------ ------------ -------------------- ----------------------- --------------------------- ------------------------- --- ----- -- --------------------- --------- ------- --------------- ---------- --------------------- --_--- ----- ------ Final Inspection by:----- -- ��. = '.i"—�-----------.�_ _ _—------ -_----- ------ --------- -- -_Rate - �� = - ------------------ - ---------------- Eli 13 24 .SAN JOAQUIN LOCAL HEALTH DISTRICT F85 21677 REV. 7176 3M