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FOR OFFICE USE: FOR OFFICE USE; APPLICATION FOR SANITATION PERMIT / Y� Permit No.._7Z_-�_� (Complete in Triplicate) - ------------------------- -------- ' � Date ., issued.----�- ---- ---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. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATIO d ---------CENSUS .TRACT------------------ sName.---- ` -� , ; Phone -- Addres' - City Zip_. o{- - 3 -d----� f�. Contractor's Name.- License #_ ___ __.Phone__ -_ Installation.will serve: Residence 3-"Aparfn4 nt House.0 'Commercial ❑ Trailer Court ❑ , ; ! /�.. Motel ❑ Other--'--------------------------- ---- - `-.------ Number of living units:-----/____-=-Number oflbedr.00ms_. arbage rinder`.'-_ ___Lot Size------- _�x a. -_�.:_______________________ Water Supply: Public System and name---- --- -- _- --- :. .---,.-Private Character of soil to a depth of 3 feet: ' Sand ❑ `%Silt r -Clay' ❑ Peat E] Sandy Loam ❑ Clay Loam ❑ a Hardpan ❑ Adobe .�Fill Materidl-___...___._If yes, type-------------------------------- [!t� t i 1 (Plot plan, showing size of lot, location of system;in relation to wells, buildings, etc, must be placed on reverse side.) NEWPACKAGE INSTALLATION: NT (No= SEPTIC TAN-or seepage pit permitted if public sewer is available within 200 feet,} i tan [ } ; K . . iize ---- - Liquid Depth Y - � � -=-------v ` -t--------Cap6city ------TYpe Material- - No. Com - Distance to near ]NeI.L_ 1 ----------------Foundation----� _ p.. _:--------------•-- d,=_.=----_-t_.Pro Lines-- : _ � � - LEACHING-LINE [�No. of Lines-------r--------------- Length of each line.___ 7�_ _,___,__r_,___.7otal Length�._._f_ _._______:____,__:__ ; i �.f 'D' Box------------T e Filter Material. !__. _,_,_,!_�_ ,e th Filter Material__________ __ _-._________.___._________..__._.___.____ Type 6_ " p _ i 'Distance to nearest: Well -------Foundation.--- 1-6- ----------- -- ------Property Line -.___!5----------- . . _f N / SEEPAGE PIT ['� Depth__p2<�......Diameter.__,.3�___ _Number______!_______.____�____� 01 Rock Filled Yes ' No Water Table,DepthT7t�m T` Rock Size I Distance to nearest: Wel]_ _-_x _-- ------Foundation__:_��__._._ .,--.Prop. 0- J�� _.__ ._ �- - � Line _ fF REPAIR/ADDITION (Preva Sanitation Permit#________________ ---________i__----__- -----Date____-:---------:------------------------------ Septic -_-__ ._ _Septic Tank (Specify Requirements)--------------- = ------------------------------------------------- Disposal ------------------------------------_-- ---------- - ---- -- - ------------------------- Disposal Field (Specify Requirements)-------=--------- ---- ------------------ ------------------------- `-----_-------=-------------------'-- ------ ------------- ------------------- ----------------------------- ------------ ----- -------------- ------ ------�---- --------------- --------- -- -------------- --------------------------------------------------- --------- - ------------------------ ----------------- - ----------------------- ------------- -.------------------------------{---------------------------------=------------------------------------- --- ---------------------------- -------------- ---------- JDraw existing and required addition on reverse side[ I hereby certify that I have pirepared-this application-and that the work will be done in accordance with San Joaquin County Ordinances, State Laws, an;d Rules and Reg lotions ofrth San Joaquin .ocalTHea'Ith Dist��cr,`Home owner or licensed agents signature certifies the following: "I .certify that in the perform ince of the work for which this permit is issued, I shall not`employ any person in such manner as to become lett to W. +fjmans Compensation laws of California."' Signed----- - - --- -- - - � - �--,----��-•�"�---- --- - - - - _ �: ;- Owner gY % .------=-------Title----------------l-- -- ------------------ Y (If other than.owner i '111FOR DEPARTMENT USE ONLY ACCEPTED BY. = = - DATE. --------------------- APPLICATION , --- - ------------------ - DIVISION OF LAND NUMBER!------------- -------------- -_--.DATE -- '-------.------____-- -------------------- --- ADDITIONAL COMMENTS----- ---- --- F - - - - - '_ _ f__________________________ _______________________ _____ Final Inspection by:--- ::._ - - =---Date---- - --- -- -- - --- ---------------------------------------------------- �� --------- ----------- eN 13 24 SAN JOAQUIN LOCAL HEALTH DISTRICT r&s s'a" e� s-