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— Y I FOR OFFICE USE: FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT �� Permit No.2� -==5SM�-' --- . .............. - --��----------- - )Complete in triplicate) - i Date --------------------------- - ---- 1 this Permit Expires411 Year From Date'lssued A 2 A plication is hereby made to.the San Joaquin Local.Health'District for a permit nstruct and install the work herein described. to co P This application is made in compliance w• h County Ord rnance,No. 5k9 a existing Rules and Regulations: 1-3 9 TGIR f...C NSL15 TRACT.. JOB ADDRESS/LOCATION - - ----- ... ... Phone...... Owner's Name.— - ----- city------------ ---- City------------ ---- -•---"�;�- 1� T 6 Address---------- .-- - - - .. - . -�� -- ........Phone-.. ,.-;��--- - -7 ..._ .--.- - License # ' Contractor's Name....... .-- - ' -- Installation will serve: fi Residence ❑ Apartment Ouse ❑ Commercial ❑ Trailer Court ❑ 4 Motel ❑ Other------------ ------ ------ ---------; .� x...- ..._--- .. -- Number of living units:...'. Number of bedrooms:: -.. Garbage Grinder-=.-=-----•Lot'Size_ ate �- .- . - -- .-.. .-Private v Water Supply: Public System and name--- .. . - Character of soil to a depth of 3 feet: � � Sand [:1Silt E] clay E] Peat ❑ Sandy Loam El Clay Loam Hardpan ❑ Adobe ❑. Fill Material.. _.-- ... if yes• ype...... ....... .. , f llocation of system in (Plot planshowing size oot, relation to wells, buildings, etc. must be placed on reverse side.) NEW .INSTALLATION: (f l septic tank or seepage pit permitted if publics sewer is available within 200 feet,} PACKAGE TREATMENT SEPTIC TANK E ) Size... r47 ------Liquid Depth . .- •--• .. ...... ) �y No. Com artments... •-- ` �apacity.1. Ll......TYPe -- Material-- 72: P �q .Foundation.----/..�. .... ......Prop, Line_--- - i Distance to nearest: Well.'_--CT- 0- ------ ------ ------ Len th-of�each- ine:•=---- _Total Length 1...6-.�----- .----- -- --- - ig �--•-------- l e LEACHING LINE [�} No. of Lines..,.��.-�--------------------- � • 'D' Box. Type Filter Material..-JAll._...Dept.h Filter Material--- --- ------------ --- - •...........................-- -- t . p�---- - Property Line---A-0............ . .... _-f..... Foundation. l Distant to nearest: Well--:- I- + f Rock Filled Yes No Diameter-. - ...Number_ ------------ --- SEEPAGE PIT Depth-. --{,- - 7 -.Rock Size..-/ - -- Water Table Depth.---•-------•----- ------- ----- ..-.Pro Line---��. ---- -- ---- J Foundation.- ---- .. --- p Permit#--- ------- ----G Q��-- .. ... ------•- ....... ...-.Date.-. . . ---------1 Distance to nearest: We REPAIR/ADDITION (Prev, Sanitation Per Septic Tank (specify Requirements)-__-'-.- ------- --•---=- --- i --,---.- P s ----------- ----- Disposal Field (SpecifyRequirements) ' - - . ------------------------------ ---- - (Draw existing and required addition on reverse side) ed this application and that the work will be done in accordance with San Joaquin County I hereby certify that 1 have prepar and Regulations of the San Joaquin. Local Health District, Home owner or licensed agents Ordinances, State Laws, and Rules signature certifies the following:p l "I certify that in the performance of the work for which this permit is issued, I shall not employ any person in such manner as l to become subject to Workman's Compensation laws of California." i --- -...Owner --- ---------- Signed.... Title- ----- ------------- I 1 at er than wnery i I O D RIME US O LY y ---- ---- ---- DATES 7` f APPLICATION ACCEPTED B --- DIVISION OF LAND NUMBE ' ---- � ...... . ......•--------------._-..DATE--..- ----------------- DIVISION -��---...-- ...- --- - ------ -------- . ....- .... ---- ---...-- ADDITIONAL COMMENTS --------------- ----�- --------------• •- - ---- --- -------------------- /_ ! ------ - --•- -�-�------- ----- Date +� .. -- -- --... -- -- . -- Final'In5pection by - .. ---- ---- -- --- F&S 21677 REV. 71767! EH 13 24 S AQUIN LOCAL HEALTH DISTRICT