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FOR OFFICE USE: FOR OFFICE USE APPLICATION FOR SANITATION PERMIT ------------------------ --------------------------- (Complete in Triplicatel Permit No._7_-_'� -_-� Date Issued..- ......................................................... iThis Permit Expires 1 Year From Date Issued Application is hereby made to the''San Joaquin Local Health Distr ct for a permit to construct and,install the work herein described. This application is made in complian6e4it-h County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOC_AT10N __:�� + ��w, ? /[�4. �_;_ - _r -_-.CENSUS TRACT _ --.-. Owners Name-'--- .�.. ---'- ------- --- ----- ---------- ti Phone- --- =---- •--- f r - -- y' CirY --Zi Address.---- Contractor's Name ------ ------- --- - _License # ��. -_-___Phone_ __ _ installation-will serve: Residence [ Apartment House L] Commercial ❑ Trailer Court❑ Nu bei of living ,Motel ❑ • Other tZ.--__-- r g units:---------1-----Number,of bedrooms:--Z---Garbage Grinder-.--.- - -Lot Size----.-� j�l - --------- .-----------------k I n` , '� i Water Supply: Public System and',name----------- -------------= ;--A-----`-'.------------ -'- ----- -�( 4 '-----------------------------Private ❑ Character of soil to a depth of 3 feet: So F]0 Silt 0, _Clay ❑ ' Peat❑ Sandy Loam ❑ ''-Clay Loam ❑ Hardpan ❑ Adobe ` - Fill Materic�l_.._.x'>�_If yes, type_--_.----------------------_-_ -�veT f , J (Plot-plan, showing size of lot, location of system in relatEon to wells, buildings, etc. must be placed on reverse side.) NEW INSTALLATION: (No`_septic tank or seepage-pit permitted if public sewer is available within 200 feet,) ' PACKAGETREATMENT [ SEPTIC TANK"[] tjFi i . Siie._ _._4----------- �-._Liquid�Depth : # - . ---- ;-- ] . Capacity. I'.- Type - '-----_--=-i._.Material--------------------------No. Compartments '` .. _-- j J Distance to nearest. Well -- i_} _ '_ "'___r ' �_Foundation----____________ Prop. Line-'--_--_►-.----._---.-=fi. LEACH WG LINE [ ] No. of Lines_ I t-- t -- Length of each line .}--- Total«Lngth __. A `:. 'D' Box------------Type Filter Material_, -- ---.Depth Filter Material---------`4----------------------------------- ----- -----------7 R. .—. Distance to nearest:Well T -----Foundation------------ - -----------.Property Line ------_ -- ----------------- 1. *,�, ., r _4 # Fi SEEPAGE PIT [ ] Depth.-. __-_ b'irmeter.. ----_:_._.- Number Rock Filled Yes ❑ No Water Table Depth " y Rock Size ------ -------------- --- ---- Distance to nearest: Well.?..-_._ "_j-------------=---------- --Foundation-_ ----------- ---------- Prop. Line_.--------------------.---- REPAIR/ADDITION (Prev. Sanitation Permit',#-_,---:--- ------------_._._-:Date----------------------------------------------} Septic Tank (Specify Requirements)—.- ' _'- -- = = = ---------------------------------------- - Disposal Field [Specify Requirements}----- e : d- s P i z = 3 x ------------------------ ----- - -- ------------ - -------------------- ------------------------------- _________________ F ________________________________________________________ .____._.________.___ -._-_ -____ --_ ____ ___ ____________ ___________________________________ ___-- ----------------------'_-_.__-_._____-.__-_____-_________________.-._---------.____._-_----.----_-----.---------__---------`--------------------------------------------------_--.---_ ..._ .--_-.-_--_----- (Waw ,--_ ti (Wa;w existing and required addition on reverse side) r I hereby certify that I have prepared this application and that the work will-be done in accordance with San Joaquin County s Ordinances,. State Laws, and Rules and Regulations ofithe, San Joaquin Local Health Districf-Home owner or licensed agents signature certifies the following: _ "I certify that in the performance of the work for which this permit is issued, I shall note ploy any person in such manner as to become subject to Workman's Compensation laws'--of California." Signed------------------------------------ --- ', -----Owner # BY--- --- /�� - -------------------------- Title �p (If t er than owner) - I' FOR-DEPARTMENT USE ONLY ' I APPLICATION ACCEPTED BY---- ......... ..._ DATE . ,,.. DIVISION OF LAND NUMBER-_- —: -- - -------------------------------------------- - �AiE.._=-- ADDITIONALCOMMENTS---------------------------!---------------------------- '" --------------------- ------------------------------------------ ------------------------- ,�J---3 -•fit ------ ` ----------------- -------------- -------------------------------------- D ��Final Inspection b :---- - EH 13 24 SAN OAQUIN LOCAL HEALTH DISTRICT �Fr6r REV. Gan