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r FOR OFFICE USE: FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT {---------------------- ----------------------- 7�--- '3� {Complete in Triplicate} Permit No.. --- ------------------------- /1-yam - Date Issued-------------- -------_-"--- __ This Permit Expires 1 Year From Date Issued 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: �. .------,70.---- - ---------- JOBIV CENSUS TRACT - -- ADDRESS/LOCATION......... ....,_.._.. -- �-� - Owner's Name. _ U� . 1✓ -- --- e..Phone z,�z -------- -- - Address �`r �/---- � r� ,�t��p city ' ' -�.cr -- zip Contractor's Name.--- License# = - Installation will serve: Residence ❑ Apartment House ❑- CoTffinercial F] Trailer Court ❑ Motel ❑ Other---- t -"' - ____Number of bedrooms Grinder.__.--__.___ Lot Size----- l�_/._ � ---- Number of living units:---------------- ,J_ ��-------- -----------------------'----� -------------Private�� Water Supply: Public System and naml� {,._.--- p� Character of soil to a depth of 3 feet: Sand ❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loaml r+` Hardpan ❑ Adobe ❑ Fill Material------------_If yes, typ' �--------------------------- W ]Plot plan, showing size of lot, location of system in relation to,wells, buildings, etc. must be placed on reverse side.) NEW INSTALLATION: (N.septic tank or seepage pit permitted if public sewer is available within 2y- - feet,} ' fj PACKAGE TREATMENT [/] SEPTIC TANK [ S`e:_�a_/ -�-��-------�gC---'=�-;-��--------------Liquid Depth _-. --u----- - Capaci#y,fo�' Of �TYPe � P Qfllaterial t �<Ao do. Compar�ments.'r ter'"-------- -"------ • '" ` � Distance to nearest: Weli_._____f_�--�------------------Foundation --- �-+5----------lProp. Line_-� I-%_-------- -. LEACHING LINE elf] No. of Lines-_-_---/._____._______ Length-of each line-----------7�------------Total Length._.__ __-'� ________ ---------- I/I D' $ox_.,�.---.Type Filter MateriaL� I_�1.�d%S Ih Filter Material--_---X�-___--------- ----------------------------- -- Distance to nearest: Well___.i� ..`. ....Foundation_ ----------------Property Line-- ----- ------------- e 'SEE P PIT [ ] Depth.-- "r.._Diameter._!�_ _dr-----Number----------/-------- --------- Rock Filled Yes ❑ No Water Table Depth -------------- ----------- ---------------------_Rock Size------- -=- - ------------ -- DistaDistance-to-nearest: nce-to-nearest: Wel l----- - -P----------- -----------Foundation.4_.(1e------------- Prop, Line.--_s14_42_.___ REPAIR/ADDITION (Prev. Sanitation Permit#--------------------------------------------------Date-----------------------------------------------1 Septic Tank (Specify Requirements)------------- y_�...___-____" ------------------------------ -- Disposal Field (Specify Requirements)-------------------= ------- ------ ------------------------------ --- -- ------------: ------ �^� _ J ------------------ -------------------------- ------------ -.-". (Draw existing and required addition on reverse side) Coun I hereby certify that I'have prepared .this application and that the work will be done in;accordarnc� with San Joaquin owner or licensed agents nts Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health_-District.,Home t signature certifies the following: ` "I certify that in the performanof the work for which this permit is issued, I shall not employ any person in such"-manner as to become subject o Wo s-Compen ation laws of California." -----------Own,, —" Signed-N, � ' - --------------------- ------ ------- By_=-------- e /i'�%' •C 3 `=--------------------- (If other than owner) OR DEPARTW JyNT USE ONLY APPLICATION ACCEPTED BY--------------- ---- DATE "-.f-_-_-- -- r`-- ----- DIVISION OF LAND NUMBER.. x DATE ---------- ----- ADDITIONAL COMMENTS-- ------------ ------------ --------f ---- - - , ., .. .� -------------------------------------------- ---- ---------- - - ---------------------------- ----------------------------------------------------- = i :c = ---- - -------- ,----------------------------------------------------- Final Inspection�y:__.__ _ _ .- Date.__ .. �.�f �'-- -- EH 13 24 SAN JOAQUIN LO L HEALTH DISTRICT F&5 2E577 RREV.EV. 7`