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NOR OFFICE USE: Y� FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ---- ' - (Complete in Triplicate) Permit No----------------------- �� ,S Date Issued------------------ ----------------._-------------.---------.--------------- 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 Regulation JOB ADDRESSOCATION-------- lg ___�� - -J1 ". � 0. Ca/L - / ----------------------------------------------,GENS TRACL-----°---- ------------------ Owner's Name .--------U/ l .. ---V- -,: / " --------- �-'-------�/ - - hone. ---.-------------------------7---- Address----- --------sem[ rem-------------------= -- -------City- Zip- - ----- - --- ------- ---------- ------ Contractor's Name 1- `-- L ". �cenSe #" Phone ----- ------ ------- -- ----- 0 e v, Installation will serve: Residence ❑ ApartWent House ❑ Commercial [rf Trailer Court ❑ Motel 0 Other________________ Nuymbei•of living units:---------=------Number of.bedrooms___�__.Garbage Grinder____.___.__-Lot Size------__ __________.-__.__________'_-_____-._______.____=-- t . Water Supply: Public System and name------------------------------------------------------------------------------------------------------------------------------------Private ❑l Character of soil to a depth of 3 feet: Sand ❑ Silt❑ Clay ❑ Peat ❑ Sandy Loam ❑ Clay Loam ❑ Hardpan ❑ Adobe ❑ Fill Materialyes, type--- ----.-„-------------""__.--- s _ ■ (Plot plan, showing size of lot, location of system in relati'on to wells, buildings, etc. must be placed on reverse side.) NEW INSTALLATION: (I o septic tank or seepage pit permitted if public sewer is a ailable within 200 feet,) n PACKAGE TREATMENT # [ ] SEPTIC TANK �' - � --_ __- N" �� - --------------Liquid Depth--------------------------- t 3 Cdpacity.-_loa _____Type____ T`' -._Materia ----------- No. Compartments-------�-_ `"� Distance to nearest: Wel __•__Foundation_,-- - 70------ Line......_"----i4.----- LEACHING LINE No:of Lines-L----)----------."_":_.'Length of"each line.-"-D ---------_- Total Length.--- / -- - r-- ' Vox-1 Filter Material- - -------------Depth Filter Material------------------------------------------------------------- t. istance,to nearest Well- _.--1 -----,(' '.Foundation----------------------------Property Line----------------------------------- '�\ SEEPAGE PIT [ ] D p h.-. --------- Di meter.- xN�rer----------= -------- ---- Rock Filled Yes ❑ No ❑ Water Table Depth. -------=- ----.Rock Size-------=---------------------------------------- i Distance to nearest: Well--------`___---_____.---- ;Foundation_________________________ -------------------- _Prop, Line------ REPAIR/ADDITION (Prev. Sanitation Permit#___________________________a"?`s___.=---"- --_.Date.:._-:--._----.--_-----.--.-___.--,-.______-__-) Septic Tank {Specify-Requirements)----..-- Disposal Field (specify Requirements) ��----r--�---�' "---------- l)--/ - � - --------------------------`-------------------------------------' ------------------------------- --------------------- ------------------- -- - -- ----------- - -- ----- --------------- --- y: - - - - --------- •.: -- ---- -- - -- -- . (�Drdw existing and required addition on reverse sidel:��-------------------- - ---- ------------ - -- ------ - --- - --- �,j +.P' i I hereby 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 Health District, Home owner or licensed agents signature certifies the following: 7 "I certify t t in h�perf mance of the work for which this permit is issued, I shall not employ any person in such manner-as to beeom subje ,t� W kman's Compensation laws of California.' Signed-= �, -------- ---------------®------ -------------cam �By-k----------------------------- ------------- ------- --:---= - - ------------------ ----------------- - ------ ' (If other than owner) F Tit e # jorDEPARTMEN SE ONLY APPLICATION ACCEPTED BY.-:. --- ------ ------ ----------- -------- -----------------------------------------DATE : ..37 DIVISIONOF LAND NUMBER--------------------- ---------------------------------=-------- ------------------------------------------DATE------------------------- ADDITIONALCOMMENTS------------------------------------------------------------------ -------------------------------- ----------------------------------------------------------- ` -------------------------------------------------------- ------------------------------- --------------:------------ -------------------- ------------------------------ ------ - ------ ---- ----------------------------------------- Final Inspection by:-------- - :-__ = = _ Date �� rH 13 24F&S JOAQUIN LOCAL- HEALTH DISTRICT '�`y ras 2ie�> REv, 776 3M