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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT permit No. ______---------------- <br /> -------------- ----------- ----------- ----- <br /> (Complete in Triplicate) r <br /> --- <br /> ------------------------------------ <br /> Date Issued <br /> ----------------------------------------------- - --- -- <br /> This Permit Expires 1 Year From Date Issued <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein <br /> described. This application is ode in co fiance with County Ordinance No. 549 and existing Rules and Regulations: <br /> ... <br /> Q - - ... <br /> JOB ADDRESS/LOCATION ___/�_--- ---,-- - / <br /> Owner's Name _ . _e ----- ---! �� 1 H------ ------ i,- ------Phone--------------------------------------- <br /> J-6e <br /> Address - ��� { �� � C�_—---- / 1 City � L --------------------------------------------------------- <br /> q <br /> Contractor's Name -------- ----- <br /> '�- 2 1`P ----License# ��_9/�_ Phone _ "'G-S- <br /> installation will serve: Residence Apartment House fl Commercial 1 :[]Trailer Court ❑ <br /> Motel ❑Other ---------I----------------------------------- <br /> Number of living units_____________ Number of bedrooms _ ______Garbage Grinder ------------ Lot Size <br /> -------- ----- ------Private <br /> Water Supply: Public System and name ----------------------------------------------------------------=""""-"--"----------- ,{ <br /> ve <br /> Character of soil to a-depth of 3 feet: Sand'� Silt❑ Clay ❑ Peat❑ Sandy Loam - Clay Loam <br /> _ -.-- *Hardpan ❑..- Adobe-©_Fili Mateuai -N.Z=wlf- es, typ --=----=_�---�------� + <br /> (Plot plan, showing size 'of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) <br /> NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,} <br /> ' ------- Liquid Depth -------------------------- kd <br /> Capacity IC TANK'[ ] Size--------------- --- -------------------- q P <br /> PACKAGE TREATMENT [ ] SEPT Type Material----------- ------ No. Compartments -------_------------ <br /> .- 1 <br /> Distance to nearest: Well ------------------------------------Foundation ---------------------- Prop. Line ----.----- • •-.--- 4 <br /> l i - <br /> LEACHING LINE= [ ] No. of Lines ------------------------ Length of each line---------------------. Total Length .---:------------------....__ <br /> 'D' Box --�---- - Type Filter Material --- Depth 'Filter Material- _____________-------_------------ -- P --------------------------------- ---------- <br /> Distance to nearest: Well ------------------------ Foundation ---------------.---- Property Line. ---------------_--.------ <br /> �F <br /> SEEPAGE PIT [ ] Depth ____ Diameter ___________---- Number ---------------------------- Rock Filled Yes No a <br /> - - ------------ <br /> t A <br /> Water Table Depth ------------ ----Rock Size -------------------------------- <br /> Distance to nearest: Well -------------------------------- <br /> -Foundation ____ Prop. Line ---------------------- <br /> 1 - _. w <br /> Date ----------------------------------} <br /> REPAIRJADDITION(Prey. Sanitation Permit# -----------------------------------------"-- � . <br /> + ----------------------------------- !, <br /> Septic Tank (Specify Requirements) ----------------------�-----� ------=-------- -------- - ---:------ -.__-<_-----------------_------•-- <br /> �; l !W- ---- - F _ xS <br /> Disposal Field {Specify Requirements) __/�dd,r���'.----- --,�---- -�•�-/- -- ".� -� "" 4 <br /> ---------- <br /> ' -------------------------------------------------------------------------------------- <br /> ----------------------- --. ._. <br /> —�— = (Drawexisting-and.required-addition-on.reverse.side) - :— <br />