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FOR OFFICE USE: APPLICATI03N FOR- SANITATION PERMIT Permit No. - /� - (Complete in Triplicate) I / -- ----------------------------- Date Issued This Permit Expires ] Year From Date Issued i ;+ 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 CountyfOrdinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION ------- -I-�- ��--------6-1--=---6 -j, -t Q1--------ESC-----CENSUS TRACT --- ----f ---------- - -� - _�_s_ . i Phone, Owner's Name _ - , Address 1 1.1--d_- 4�- v City,�,� -SCA� --- -----��- —11 Contractor sName ---------��_��r---------- ------- -- - - - - License #t f --------------- Phone / Installation will serve: Residence partment House❑ Commercial ❑3rci lerCourt ;❑ Motel ❑Other ------- --------------------------- - --- A 1� Number of living units:--..-[--_--- Number of bedrooms -_I--------Garbage Grinder - Lot,Size °-----_ jp4- ,� " s ------- Private [ � Water Supply: Public System-and name ------------------------ --------------------------------------- -------------- -_-- Character of soil to a depth of 3 feet: Sand'❑M Silt❑ Clay Peat❑� r San y Loam Clay Loam ❑ } € e ------------- Hardpan Adobe' Fill Material --Iv-CJ 14 es, type (Plot plan, showing size of lot, location of system in relation to wells, buildings,(etc. must be placed on reverse side.) . 1�" -------------------- - --� _�_f_. -- Liquid �0 feet,} NEW INSTALLATION: (No septic tank or--6 l page pit permitted if public sewer is aviaifable within 2'Depth -------------------------- S� PACKAGE TREATMENT [ ] SEPTIC TANK' Size------__ Capacity.-------------------- Ty/- -------------------- Material--------------- Compdrtr en#s Distance to nearest: Wil ---_--.Faundatiori --------- ------------ Props Lina -------•------•------- ------�•-----= LEACHING LINE [ } No. of Lines ---____--- :--_ _- Length of each line------- Total Length ___-_-.-_-,_-_-- r�: _ I D' Box ------------ Type' Filte Material ---\---------------Depth Filter Mat rias ------ -„-------•------------------ I, , Distance to nearest. Well --------------------- Foundation ----------- ------- !'_ -_- Property Line. __--_--.----------•----- SEEPAGE PIT [ ] Depth Diam ter ----------------i Number -------- ---- -- -- Rock Filled Yes ❑ No i❑ ' fir. � '�~ Water Table Depth ---------�------------ i----------••-Rock Size -; ----- - ------------ Distance to nearest: Well ------ ------------- Z, ------- ---- --- Pap Line ----_--_-_...-_-_.____ 3 •-------- , € 1 REPAIR/ADDITION(Prev. Sanitation Permit# t --Date _--_ _.--- ------------------} } ptic Tank (Specify)Requirements) "~ s - ': ---------- SefM CH----------------- ---------------------- E- f y. frl- �[ = _ �., - Disposal; Field (Specify Requirements) -__ ---------------------- .-- - s 1 TX , - --J- ----- ----- ------ --; U (Draw existing and required addjtion on_reverse side) I hereby certify that I have prepared this application and that 'the work will be done in accordance with San Joaquin P County Ordinances, State Laws, and Rules and,Regulations of the San Joaquin Local Health District: Home owner or licen- sed agents "TMure certifies the following: "I certify i he,pe mane f the work for which this permit is issued, I shall not employ any IPerson in such manner a�toec m bject to k 's Compensation laws!of California.” -- --------- ------ ----------- Owner ® n ------------------------------ -- Title = I (If other than owner) ! FOR DEPARTMENT USE ONLY 1 APPLICATION ACCEPTED BY --------- ----U _ ------------ ; = ---- DATE BUILDING PERMIT ISSUED ------------- - -- ------------------------ ------ ------- �- ------------ '--------------------DAT ADDITJONAL-COMMENTS_ — -� - - 3. ="- - = - ----------------------- --- - ------ --------- ------- � - _---- . _ _.� ------------------------------------------- ------ ------------------------------------- ` f -- - - --------- - -- - ------ Final Inspec i Date SAN JOAQUIN LOCAL HEALTH DISTRICT C u 0 1-'AR RPv- SM