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FOR OFFICE USE: "i FOR OFFICE USE: �' APPLICATION FOR SANITATION PERMIT 31 1 4y...-- r w.. �t [Complete in Triplicate] Permit Na._..7�--_ ------------------- � a "- f �� Date lssued.--------`--------- -----------_-------- -- __!/_--_--------- --------- -. This Permit Expires 1-Year From Date Issued y Application is hereby made to the San Joaquin Local Health'District for.a permit to"Con strucF and install-the work herein described, ` This application is made in compliance with County Ordinance No, 549 and existing Rules and Regulations: t JOS ADDRESS/LOCATION - ------------------CENSUS: . � TRACL- ----- --------------------- Owner's ---------Owner's Na_me--------- - ------- --- --- - - ------------ - ------------------- ---------------------- ---- -------- --- -------------------------- ----- Phone .. Address- . G - - -------- -' itY C ------------------ ---'-----------Zip------- ---------=--- Contractor's Name------ � -.__License Phon - & _-7 _ -❑�Apartment"Hous8.❑ C6mrcal-n' Traler Court ❑Installation will serve: Residence i 4 Motel ❑ V C'tther-----:------------------ ----- -------------- p� Number of living units:_ .----- --Number of bedrooms_:___�7-_"Garbage Grinder------------Lot.Size------14."L ' �--------- ---- Water Supply: Public System and name----:-'------- ------------.------ =-.----------=------------------------ ---------------------- - ------Private ❑ Character of soil to a depth of 3 feet: Sand E] rSilt E] Clay L] Peat ❑ Sandy Loam Clay Loam ❑ y Hardpan ❑ Adobe ❑ Fill Material-------------If yes, type----------------_____-._-.----- 1 [Plot plan, 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 available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK"[ '] Size_ l ----------- Depth._'_-.------------------sLiquid � Ca acity"J__5Z ---Type___- Material----- ------"No'. Compartments6 Distance to nearest: Well_-__ _ Foundation.../�__.___._-- =._ Prop. Line----"r .._____- i Nof Lines- --_:-- """""'_Len th of 6Rh'Iins,._____ . ------------Total Len th =. LEACHING LINE [ ,lf :-. g � g 10- -------------------------- 0. - 'D' Box_": a Filter Material'---_ h FMaterial ----------------------------------------- ,._ Depth ateral---- - --- - . --� t �-- - -TYP W - Distance to nearest:Well-----------------------------Foundation__-.--._- __.______ ---.Property Line-------------------------- __.�__ p t Number'--`-'-`--�--------k---- -- Rock Filled Yes No__ SEEPAGE PIT [ ] Depth __--_- Diameter__. f E Water Table Depth------------'•-----------------------------------------------Rock ize - ----- --------------- n---- Distance ------- -- i. Distance to nearest:"Well--_..____ __ _ (,� _---------------Foundation._">----- - __-" Prop. Line REPAIR/ADDITION (Prev:Sanitation Permit#-------------------------------- Date -------- -- ---_==---- -------------- ' Tank (Specify Requirements)- ------------- - ------- = E, --------------------- - ---------------------- Septic Dis `0-^ ------ Disposal Field {Specify Requirements) ---- -=-----: - -- ---- - - - ---- -- :----- - -------- ---:------- -�- - --------------- -------------------- - [----------------------------------------------------------- '-------------_-- ------------ ---------:---- --_ ; - ------------ -----------------------------------------------------------, ---------- -_-------------------------------- ----- (Draw existing and required addition on reverse side) ; 1 hereby certify that I have prepared this application and that the .work will be done 'n 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 "1 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 becorfii"subject.o Workman's Compensation laws of California.". ._ ,.. Owner - ' BY •. rG. � ----- Title -.-- --- < F ... i (I other t an owner) . s ` -- 'FOR DEPARTMENT USE ONLY _ I �_ �� . DATE.:. -7 =------- ---------- APPLICATION ACCEPTED•BY:=�----_- `'- ---------- ---- ---------�� - -------- ----- ----------------- - -� DIVISIONOF LAND NUMBER--------------- -------------------------- '_" ------------ ....................:----------DATE---------------------------------------- -- -- ADDITIONAL COMMENTS-- -------------------------- ----------------- `------------------- ---- = --------- ------------ -------------- ------.--- ----------------------:..--------------------------------------------=---------- -- = -------- ------------- -7F&5 21677 REV. 7/76 3M Final Inspection,b .� - --- .. .�.--.--- ' = - 1 --Date - -CYTS-I__ .-__.. p y::-_"--_____ - EH 13 24 SAN JOAQUIN LOCAL H ALTkq DISTRICT