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FOR OFFICE USE: FOR OFFICE USE: APPLICATION rOR SANITATION PERMIT 7 Permit No./._-2 ---------------- ----------------------------------- ---- (Complete in Tripiicate) --------------------------------------- ----- Date Issued-/e- `7 7 i 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 Coun Ordinkne No. 549 a existing Rulesand Regulations; 7 7, 4 / '-_� TRACT ---- ---------7 -------- _ -CEN U5 JOB ADDRESS/LOCATION.__) GC.f --------- - --- ---- ------ ----- Phone _ Owner's Name- r Address------------- ------- - ----- - -- ------- - -------- -_-------- -- Q•�ifJ License #------- --------------------- Contractor'sPhone__ �{— :. - Installat onw ll serve: Residence A artment House.❑ Commercial ❑ =Trailer Court ❑ '0-- p _ Motel ❑ Other------------ ------------ - / c Number of living units:___ Number.of bedroomst„.-.-Garbage Grinder--- .-=--Lot�.SizeGX__- -_----- ------------------- - -----Private ❑ Water Supply: Public System and name----- ::• ------ - :--•------------ i Character of soil to a depth of 3 feet: Sand ❑ Silt❑ Clay ❑ ° Peat ❑ Sandy Loom ❑ Clay Loam ❑ Hardpan ❑ Adobe❑ Fill Nla.terial__.-_ _ -._.1f yes,type----------_-_______--___. _ ' buildings,`etc. must be placed on reverse side.} r (Plot plan, showing size of lot, location of system in relation to wells, NEW INSTALLATION: (No septic tank 'or seepage pit permitted if public sewer is available withi 200 feet,} { Liquid Depth. "�` - PACKAGE TREATMENT [ ] SEPTIC TANK { Size_-_ '_:_____--- - t No. Com artments------ -- Capocity_/Pe Type.62 ��'�� .-Material_.F � `� p _ P Distance to nearest:.Well._-.-_��-_-_--- -•=---=- -- .�__: --Foundation--fC -------=-- - ---Prop. Line---- - --------- ' Length of.each line - ----- ------ - o Length - �� LEACHING LINE No. of Lines..:::- ,_==- _-::-- 9 T tai -- -- it F ; p `� l� t D' Box--A._'_-_Type Filter Material-r --y:---r --fie iter Material_-____ _ r Property Li _ - ------------ Distance to nearest: Well-.--/"-.------ -----Foundation_ f-Q ^� tYne -e No-E] - _ - -�, Rock Filled Y wy SEEPAGE PIT ] Depth' .2I S__ _ Diameter_ _ ._ Number Rock 51z . - .}- ---------Io a--- -------- se 1 Water Table Depth------��- -� --=------'-- --- - "-- ' i _. Pro Line Distance-to..nearest: 1Ne11. _-_---- � y ,Foundation--- - ----- ------ A ( REPAIR/ADDITION (Prev.:Sanitation Permit#_.---- .; i Septic Tank (Specify•Requirements)---- ------- -------------------------------------- '---- --------- --------=-----------------------=-` ------ --------=------------ ---------- ---------------------- - v ;i -------------- -- ------------------ -- Disposal - Dis ----------------------- _ --- ------------- ------------------------ ;._ 1 - -_ _ ____________ _-__ ____.______-- -_ ___-_____F--------------------- ------------- -_ ----- --- - _______________________ _ (C)raw ezistrng 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 �. lations of.the San Joaquin Local Health District. Home owner or licensed agents Ordinances,' State Laws, grid Rules and Regu signature certifies the following: ' j 1 "l cern th tin the erformance of the work For which this permit is issued, 1 sh II not employ any person in such manner as to bec me ubyect o W an's Compensation laws of California." I ned-- --- ___Owner Sig E � ' BY ------------------------- ------------ Ttle, `. :--- - - l S (If'other than owners `3 - i� s FOR DEPARTMENT USE ONLY �. APPLICATION ACCEPTED ---- '�-" - -- - `-- -----_----- = DATE._ - =-- r ----------------------- ...---.DATE-------------- DIVISION OF LAND NUMBE fr �' ` ADDITIONAL COMMENTS_ I(� _ha-'I'1 .a" , , 5 - -- ---- - k _____________________________:_._ _ _ .___-__ ____________________________________________________ _____ _ ---_-_.____ _ __-- __-__4 ____-. _ ____________ __-_____.____-_________.-______ ----------------- -------------------------------- ------ __ - -7 ��40A - '------- --------- --------- -------- --------- - -- ,.Final-Ins ection b -- - -- ------- F85 21677 REV. 7/7b 3M EH 13 24 SQUIN LOCAL HEALTH DISTRICT