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F � __^�` -' •a. "� +rte' � "��,r�1 — � - E FOR OFFICE USE: FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT (Complete in Triplicate) Permit / .- ...-_... / Date Issuedl ----- -__._ _.... -4----------- --------- -...__.'____..___St - 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/P ' TION __ ! , - .. 1 ,.: � --- - ---- ---- �--� ------------------CENSUS TRACT- -------- -- ---- --- ---- ------- - Owner's Name. - AddressIZ ... .� 'fir W� Phone ., - - --- ----- --- City.. � Z_ .�_, -- -- ZiP-�.Contractor's Name- -- -- --- ---= -- .LicensePhon �' 6`.#•� --- e- _ f� . r Installation will. serve:• Oe?iclence Apartment House.❑ Commercial ❑ Trailer Court ❑ . i Motel ❑ Other= -----=-- ;.__ '... .;_ w'. Number of living units:-.- -----Number of,bedrooms.------------Garbage Grinders,,,.,__-Lot Size------------ i I 1 ,, Water Supply: Public System and name.-- _- ;.- -.;-�--- -- -------- --Private Character of soil to a depth of 3 feet;" 'Sand ❑ 'Silt❑ Clay ❑ . Peat❑ Sandy Loam❑ Clay Loam ❑ 1 ' -�--►Hardpan'�-Adobe [] 'Fill Material __--2------If es, t P g Y type ------------------------- ' (Plot plan, showin 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.._____-:-__s_-- ►!w ------------------------- -Liquid l uid Depth---- --- -------------- R Capacity- / - i ., d M`- = ` Material_ ---------No.(Compartments----=-- -- 1 4 Distance;to nearest: Well_;,: so.:--W,- R------Foundation__1 - -------------Prop, Line.-- ` � L(NE� � •l '- / ------------- LEACHING [ ] No. of Lines-'=------------`-,_-.---------Length.of each line... :Total•Length- 7 _ Ii ------------- 'D' Box _ -...___.Type Filter Material_-.- ------------- Deptli Filter Material-_ _ ---_____ --------------- t ,.. Distance to nearest: Well- - -------k---- - ------Foundtion--- -- ._ _-.Property Line------------------_--- _ ZSEEPAGE PIT Depth. Diameterm ..� - --=------------------ uer- --- ----- Rock Filled Yes ❑ No Water Table:Depth - ------ -----------------------------,-...Rock Size--•--- ---------- --------------------- t Distance to nearest:Well-- .-------- ----- - - Foundation---------------------------Prop. Line.---------------- F .. REPAIR/ADDITION (Preva Sanitation Permit#------------------_-_------------- ----Date Septic Tank (Specify.Requirements')-- ---------------- =------------------ - = : Disposal Field(Specify Requirements)------ ------- ---------------------------- -------------------------- -------------- ------ - - --- -------------- - - _ -------. - --------------------------------- ---------------- --------------- ----------------------------- ------- _jDraw 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 f Ordinances, State.Laws, and R_?les and Regulations of the San Joaquin Local Health District. Home owner or licensed agents signature certifies the following: "I certify that in theec to.Workman's of.the work for which this permit is, issued; I shall not employ any person in such manner!as to become bjtWorkman's Compensation: laws of California." Signed �, f ------- ------- -- ---- ----Owner ' �. �� BY *- =--------------------------------- :--- - ---- -----.` -----Title ----(If-other than owner) - j--------- FOR r DEPARTMENT EIE ONLY APPLICATION ACCEPTED BY -- -- -------- � - ----- - -- DATE_. DIVISION OF LAND NUMBER------------- -- ------ -- - -- ' ----' .DATE-------- ---------- ADDITIONAL COMMENTS- ------------- - " ---- -. --- 1 ---------------- ------ ----------- ------------------------------------------ ------------------- -- - - ------------------- -- -=---------------- Final Inspection by:.-_ ------------ -------- --- ------ Date --- -- -- - -- ---- _ E" 13 za ------------- SAN JOAQUIN LOCAL HEALTH DISTRICT fes 21677 REv, 7J76 aM