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�[ FOR OFFICE USE: FOR OFFICE USE: Il I. APPLICATION FOR SANITATION PERMIT ----------------------------- - - ---- i Permit (Complete in Triplicate) ------ ---------------- i II Date lssued�--_7 -A 7 ------______--------------- This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. I Th'is application is made in compliance with,County rdinance No. 549 and existing Rules and Regulatyon;i:. _ t N ------- owner's ke-° -- --r--- i - -�. - CENSUS_TRACT V-- --------- -------------- ----JOB ADDRESS/LOCAT Owners Ndme-------- N-w =--- ----------------- - ---------G--1-------------- ----. one------- --- ---------------------- C -_----_---------.- CItY-Address_ --- ----------- . 4 ------ License _--------------------------- C' ntractor s;,Name--- ---- ------ -------------------------- Installation _ "` - Installation will serve: } w _Residence a Apartment House E] Commercial ❑ Trailer Court ❑ - e _ _ I! i f•-,,. �,•- ;.».�-�._. -� Motel ❑ .Other = - ---: _� ..,_--.. �� w f Number of living units:_; __.__ ____Number of bedrooms__.__.z__.Garbage Grinder.- :Lot Size ___._ ------------- --- �l ry e t Water Supply: Public System and'name _ :.. .. -- ------ ._ :---------- = -------------- Private M1❑ II t - -- _- Character of soil to a depth of 3 feet: Sand [� :Silt❑ Clay, ❑ Peat Sandy Loa ❑ Clay Loam ❑ --If es, type Hardpan -1 Adobe ❑ Fill Material_.-_. y ------------------ (Blot pian, showing size of lot, location of system in relation to;wells, buildings, etc,must be placed on reverse side.) ` NEW INSTALLATION: (No septic tank or"seepage pit permitted 'if public sewer is availabie within 200 feet, ` Size - ----------------- ------------ ^ fluid Depth . PACKAGE TREATMENT [ ] SEPTIC TANK "['j ' f i a Capacity--= Type Material :� - o en N` Compart, is ----� P Distance, Fou dati n ------------------ --Prop.r Line --------!-� -- a Total Len th __ ..___. r - Len . - h line._:. ..:._' F: g 'D Box__._._---.._T a Filter Material:_ i _j YP or-eac Depth Filter Material .: ----------- '--- LEACHING LINE. [ ] No. of Lines,_- • ___ g t. _..F --------- Distance,to nearest: Well_'------- ---------- --Foundation --.Property_Line---------------------------------- G Number ... l SEEPAGE PIT [ I Depth--- - ---------Diameter--------------------" ---- ------- Water --- - i Rock Filled Yes ❑ No r.i l Water Table Depth -- = RockSize!. L' ? _- ,Foundation _- �f -.Prop. Li - - --- REPAIR' r� ] Disfiance,to nearest: Weil_.._.__ n ----- ------------------- ------------ f f ) I� /ADDITION (Prey. Sanitation Permit#_______________��_::__ 'Date---- [ f . , I = ____:_.a. - ------------- ------ ! Septic Tank i(Specify Requirements)_________________---_---=-r:.:'"- -- == Di oral Field(Specify.Requirements]:�G� ---- ------ ` ¢- �- - _ - �i =------ - -- --- ------ ___ ------_ _____________- ' = �' ` --- -Draw existing and required R e uired addition'on.reverse sid6) I herehye>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 HealthIDistrict. Home owner or licensed agents signature certifies the Following: . ! ` i "I Certify that in the performance of the work for which this permit is issued, ,I shall not employ ariy;persan in such manner as to become 'subject to Workman's Compensation;laws of .California." Signed---------I----- ------------------- :------ � Ownex = . 'l 'r� Title --------------- -------- - ----- ---- _� ---- - i) (If ofher tHon owner) .. FO DEPARTMENT USE ONLY IAPPLICATION ACCEPTED BY -----_--= --- - = = ._DATE..--3 --'�� IDiVISION OF LAND NUMBER ----------- --- ---=------ -- -- -------=-----r=-------- -----_--------------------- -------------------------- ADD _---- --- E DAT - --- AD'DITIONAL COMMENTS--- ---------------- ---- ------------- --------- - ------------ - ------------------ ----------------------- - __ - R ___________________________________________________________________________ ______________ . _____________------____________________ _________________________ . k -- - - __ _ ---------------- -------- ------------------------------------------- -------- - ----------- ______________ ________ ____________—___.______.__._______________._____.___..__._--___ ----------- _____ a_ ----_______ ___----___________ ___ _ _ _--- _r - �� - _ ________________________________________________________________________________________ __ ------------------- ---- } R�....�.._ ate_ /�C __ .------------------------- k IFinal Inspection-by:- ---_._ - --------------------------r ---------- ------------ !/ I�eH is 24 SAN JOAQUIN LOCAL HEALTH DISTRICT Fas 2ie�� Rev•7I�6 inn s