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FOR OFFICE USE: FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ---------"--------- ----- �g-�2-s' l (Complete in Triplicate) Permit o__ ____ _ _ ----- Date Issued_.1__r� _=�-g^ ,,,,____"---.___._.-_"------------_-----_----- --- -- This Permit Expires 1 Year From Date Issued i L 7.O v u�i✓5/L Application is hereby made to the San Joaquin Local Health District for a permit to const l'ucMcl install the work herein described. I This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION. <, --------CENSUS TRACT------=---- :------ Owner's Name-------- F - - l°'S .. --- -- -.Phone-- Address----------------- ----------- ---------------------------------- =- ------i------- r Ci . -- = ' ------------------Zi Contractor's Name.-:-------�.l _.____-- '- Licenses# : - ---"----------- ----Phone_------'--.----____-- _ ------------=--------- ----- R . . .:�. P . ; ❑ H. . 0.I s: � Installation will server q -�� Residence A artment Hause. Commercial i Traller.Court ❑ - �._ Motel ❑ Other_ -----------------------------------:- e;T Number of living units:----------------Number of,bedrooms Garbage.Grinder---`--------Lot!,Size'----- _ ----------- --- - Water Supply: Public System and name--- -- -----'_-_--:---_ - r ...E_. .. . ." -` . ._ s - --------------- ---------------Private E]Character of soil to a depth of 3 feet: Sand.: .Silt E] „Clay ❑ , Peat.[] _ SanclyLoam ❑.:_ Cl4 ay Loam_❑ Hardpan ❑ Adobe-❑\� Fill Material__. ------ yes, type----------------- {Plot plan, showing 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 it,' errnitted if public sewer is available within 20d feet, _ { p. _ Pi ,P�� P ) PACKAGE TREATMENT [ ] SEPTIC TANK" [ ] �/X1J71' lir---__----__ --------------------------------Liquid Depth----------------------- O Capacity----- --------------TYPe---------- _'Material:_ _----`--= --------No. Compartments------------- ------- ----------- g .. � Dist' Jo nearest:.Well-------------------------------------------Foundation--------------------------Prop. Line—------.:___ LEACHING LINE- No_•of Cines------------------------------.Length of each Iihp ___,_ ._ __ �v Total Length.=___ _Q______ ------ ` *'D' Box �__'_ Type Filter Material/�� i. a h°•Fi!#er Material_)---- _ __ ________ ! _ Distance to nearest: INeIL___ f ____ ______`Foundation__. : ___---- ___.Property Line__________________ __ ___ ___ ] P SEEPAGE PIT [ ] c Depth `' '��_.Diamete-------- ___ Number_ k -- Rock Filled Yes ❑ ` Not❑ Water Table Depth 4-------------i-------- -e--------------------- � - - " . . Distance to neatest: Well-:------------ -------'--`"` -r'---------.Foundation_".__ _._---____ :_.Prop. Line--------------------------- '_� 1 . . { REPAIR/ADDITION {Prev. Sanitation Permit#--J----:------------------------ -- rDate_k........ --------- I Septic Tank (Specify Requirements) - = = _ - f -=----------'------- ------ ----- . ' Disposal Field {Specify.Requirements)_------ -------------- ______________________________"_..__----- -------------------------------,. - --------- -------------7--- ---------------------- _ _ - = -: --- =------------------ - - ------------ r-_ .. . (Draw existing rind-required addition on reverse side) I hereby certify that I have prepared this application and that the work wil[z be-done•in accordance with San Joaquin County Ordinances, State Laws-, and Rules and Regulations of the San Joaquin Local Health,D'istrict. Home owner or licensed agents signature certifies the following: Y "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 to become sub'ect a rk an`s o sof California.,"'.- 'z _ Signe"'- I --- pe ation law -- ------ -- - <'� - - ------- =Owner -.• '�. . - - BY ----------------------- --------------------------------------- - ------ ---.-- - ---- --------------- -------------------- ------"------------- {6f btKer than owner} } ""FO&DEPARTMENT USE ONLY f APPLICATION ACCEPTED BY__. #.__.__ .+ ` ~= ------' DATE-_ 0 DIVISION OF LAND NUMBER------=�------'------- -------=----- ---- -----------------=------ ...DATE----------------------------------- -- --- --- ADDITIONAL COMMENTS =---- -----------------------------=•-----=---- -- - -----------=---------------------- ------------ =--- ----- -------------------------- ------ -- --------------------------- ----_------ -------- -------------- -------------- ---------------------------- ---------- ------------------------------- ------------- - - ----- --- ------------------------- --- ----- -- ----------- `r ------- ---.---------------------•----- -----1 - -- --- - ---------- �y - -- Final Inspection b -- ----- -------------- _= -'T ` ---------- --------- -----Date .'l r i ce? -------------- EH ------- ---EH 13 24 r SAN JOAQ N LOCAL HEALTH DISTRICT F&S 21677 REV. 7176 3M F