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FOR OFFICE USE: FOR OFFICE-.USE: APPLICATION FOR 5ANITATION PERMIT Permit No------------------------ -------------- {�--�- ----------- fa» (Complete in Triplicate) f 13-- . Date Issued.-----' . __.-_-_ --- - This Permit Expires 1 Year From Date Issued Joauin Application is hereby made to the San with Local CountyOrdintancce5No. 549 and existing construct g Rules and Regulations: work herein described. This application is made in compliance _ i �. } F,7. _ ------ ------- ----- ----- CENSUS TRACT �— ---------- ? JOB ADDRESS/LOCATION--_- {- . �r /-.10�t�Q--- ------ Phone-f - /- -- -- Owner's Name----------- - --- ----------- - --- ----------------- Address. - J�4-- ----- .- ---- - C tY Zip--- .. License #-�-��-- Contractor's Name__ ----------------------- ------ ------ -------- -- _ I Installation will serve: --"" FResidenceX'`Apa&t ei nt•House ❑ Commercial E] Trailer Court C]� Motel ❑ Other---------------------- ------ ---------- ir ------ _._ ---Garbage Grinder__._. __Lot 5ize.. -- -------a` -- Number of living units: _ -------Number of,bedrooms LQ - Water Supply: Public System and name_________ _ Clay Loam El Character of soil to a depth of 3 feet: .Sand ❑ :Silt ElClay ❑ ' Peat LlSand Y Loam ❑ Y ! Hardpan ❑ Adobe Fill Materiak__..._ -..__If yes, type----------------------------- Plot Ian, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.} ` f( p NEW INSTALLATION--"—`{No'sepfic tank or seepage pit permuted if public sewer is available within 200 feet,] -PP+CKAGE TREATMENT I l SEPTIC TANK [ l Size------------------------------------- ---------------------Liquid Depth .------------------------ �1 r ----------------- mpartments. --------------------- Capacity . rial No. Co ------------------- Ca acitY ----------.- .� .-Type = Mate ---------- Foundation -------Prop. Line---------- ----- Distance to nearest:Well. f - 4 ____________________ .� Total_Length~_--.--T LEACHING LINE [.] No. of Li�es ------------------------ Len th of.each_line:,_---��_. T-.--- Yp k_ g ---. p -------------------------------------- ---- --------------------------------- _._- --Type f=ilter Material---------------- Depth Filter Material_.______:__.-_.---.------ -- ' Property Line------------------- Distance to nearest:Well_______________ ______ Foundation___. -________ . , ... . Rock Filled Yes ❑ No ❑1. r SEEPAGE PIT [ 1 Depth----------------Diameter---- ---------=----Number------------ -------- t �^ -----.Rock Size.---- ----------------- ---I------------------- C it,t Water Table Depth-----------------=------------- ----------------- 7'77 --- --.Prop. Line-------------- jDistance to nearest: Weil-------------------- - -------- =------Foundation._:...----.------ - •-. ---------------`-----.--- ---------Date------------ -- ----- ) 'REPAIR/ADDITION (Prev. Sanitation Permit#_._-_.--._ ---- � ------' Q _ . + --------------------- =---- --------------------------- --------- Septic Tank (Specify Requirements)--------- ----- ---- _ ------ ---�---- --- "" fir/ , ------------ j ------------ Disposal Field (Specify Requirements}-" .�•-- - -------------------------- - - ----- ---'------ f , r -- ------------------ �. i. ` --- ------- i �- ---------- --=----- - ; [Draw existing and required addition on reverse side) I hereby certify that 1 have prepared this application and-that the work will be done in aceardance with San Joaquin County tions of the San Joaquin Local Health District. Home owner or licensed agents Ordinances, State Laws, and Rules and Regula signature certifies the following. �» r f E t "I certify that in the perFormance of the work for which this permit is issued, 1 shall not employ any person in such manner as to become ublect to orkipan's Compensation laws of California." f Owner Signed --- --- - - ---------------- Tit1. le-- ------------------ (If other than owner) ~ - ,.... FOR DEPARTMENT USE ONLY ►� APPLICATION ACCEPTED BY- ---------- ----- --- -- -DATE - -- � .DAT ------- DIVISkON OF LAND NUMBER------------------------ - - ------ -------------------- b L COMM 5. - �.:.:. f APD1T N-4 -- - -- f - ' f 3. ---=---"- - _ -- _ .7 ---- _______ _________ _____ __�_.__---____._ ___ ____ __-__ __---_____---._____-_"__.__--______ ._- ___---- - - ----------------- ------ - - Date.. Final Inspection by: -------------- fes 21677 REV. 7h6 3µ EH 13 24 SAN JOAQ N LOCAL HEALTH DISTRICT