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FOR OFFICE USE: FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT --- (Complete in Triplicate) 1 r j-r Permit No.7 � � ------------------ `---=------------------------ "I Date Issued-.e�f_: --------------------- This Permit Expires 1 Year From Date Issued i 4 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 Regulations: w � '' " jt� �Q F SUS TRACT------------ JOB ADDRESS/LOCATlO .__,__ .._.._ G ' hone____d- a --------------- ---- --- ----- Owner's Name ----- ---- - - � ------- -P �7--- -- -7-�- ; . Address- -----` =' - :. .."------------------City "---- ------- --- ------------------------- Zip F Contractor's Name--------- `1_j0ta�-------- ---------'------'------=-------------=------ - i -,-,..License #------"- -------------- Phone4 Installation will'serve: Residence apartment House.E] Commti e al E] Trailer Court ❑ F x Mot` el ❑: ,Other_ Number of living units------ ----------Number_of bedrooms_._._-__ ,_Garbage Grinder._----------Lot,Size----------------------------------------..-,-------------=-- Water Supply: PublicSystem'and name....`. --- ------ -------')------ --- -- _ ----- -------- .-.: . ---------- -. ------------- Private ❑ Character of soil'to a depth of 3 feet: Sand 0 Clay—E]Cla �'Peat E] Sandy Loam ❑ Clay Loam El ; ; - .. y I Hardpan ❑ • Adobe=❑ :- iIIMat6rial_=._.n - If yes,type.- ? -------------- (Plot plan, showing size of 14, location of system,,irelation to wells, buildings„etc. must be placed on reverse side.) I ' NEW INSTALLATION: (No septic fdn`4or,,seepageipitspei'mitted if public sewer is available within 200 feet,) s PACKAGE TREATMENT [ ]� SEPTIC TANK (10 Size_ ----------------- ------ ------------Liquid Depth------ --------_----- ----- �, C .4 . Capacity- =�YPe= - 'Material -- 0 Compartments t�., -' �'' �•; `gid}i -- ------ ----------- -- ` Distance.to-ne rest: Well __ ' -`-- Foundati Prop. Line W ,t [ [ T 1446------- al otal Length._ LEACHING LINE Nor;of .Lines_”_,___I_ -_ ------------ of each line 1 } '.'D' Box-------" Type Filter Material*_;.,.-- -- Depth Filter Material----------------'--.----------------------------- Distanceto nearest: Wel l........ ____�.___-fl-Foundation----------_ _-------------Property Line---.________.________--------------. SEEPAGE PIT [ ] Depth________________Diameter _"""�-•----- ----Number_--______:_______.R___-------- Rock Filled Yes ❑ No ❑ f� - ----- =- - ----- ---- - -----------Rock Size_--=----------_-- -----------------me V to nearest: Well_..:::: - - 'i �/ r Water Table.De th_________ ______ "71 /` [ m-_-_,Foundation: Prop. L ------------------------ DistanceI t 5 a WI REPAIR/ADDITI (Prev. Sanitation Permit#-------------=----------------------- ----------------Date.----- ----=-----------------------------------------------------------------------------------) Septic Tank (Specify Requirements)--------------- ----- ------------------------t--------t---------I_- ----------------- -- Pit osal'Field (Specify Re uirementsJ---- --. 11 l�-[a Y'__C -----"-------=------------------------------------- ---------------------- P Y . q O ---------- ---------------------------------------- ----- ----f------------------------------------------------- - .------ _-----------------------:------------------------..--.-.---------------------------, ---------------------- -,-- -------- ---------------- --------------------- ---------------------------------------------------------------------------- ------------------------------------ .-- -------- ------•---- -------------------- ---------- - ------------ ------------ ----- A { g q �4 ��= -- �� Drawexistin and re uir'ed 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 Count} Ordinances,' State Laws, and Rules `and Regulations of the San Joaquin Local Health District. Home owner or licensed agent( signature certifies the following: k "I certify that in the performance of the work for which thispermit ' )ed, I shall not employ any person in such manner c to become ct to or•k n' Ca pensation, laws of Califo ia. Signed. = ;i ---.---- ,OWner ---- - --- - -- BY ----------------- -----------=------- -------_ -- -- - ---: 3 i e ------ -------- --- (I'f other thcin':ownerl ` . r i FOR DEPAR ' ENT USE ONLY' a - -n-------------- t _- APPLICATION'ACCEPTED BY--:-- - --=------- - -------------------- DATE F DIVISION OF LAND NUMBER------; ----- ------DATE--------------- -------------------------V --- ADDITIONALCOMMENTS------- --------------------------------------------------------- -------- ------:----- ------------ --------------- ----- ---------- ----------------------------- . .. = ----------- ------------ --------------------- ----------------- ------------- ------------- -- ---- - --- -------------------------- -------------------------------- ------- •-- --------------- - s L.eM - - --- ----- __ _ _____ _______________________ .a `•, r.____""__-_.----_-_-_-_-_.__---._.-____.__---- ___ __ --------------- - .__ ------ ----------------------------------------- D Final Inspection b - �f._ ate ----�-------- EH 13 24 SAN JOAQUIN.LOCALHEALTH-DISTRICT F85 21fi o REV, 9/7d 3M .Y