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FOR OFFICE USE. Q---- --------------------- - APPLICATION FOR SANITATION PERMIT FOR OFFICE USE: ----------------- --- {Complete in Triplicate! Permit This Permit Expires 1 Year From Date ate Issued Date Issued...._-_-�S_ 7� Application is hereby made to the San Joaquin Local Health District for a permit to construct and in the work h This application is.made in compliance with Count Ordina ce No. 549 and existing Rules and Regulations: r _ _ described., JOB ADDRESS/LOCATION.-- � Y �'� - ! .�rr-- -- ---� - - "--•--��-� i ....�• .n Owner's Name L� CEN TRA s ---- - -- t` -cr.--- ----------- ---- - - ---------- ------ CT c ----- Address--_ Ph Contractor's N _ .. .£ ame_ f C1 o Zip - ------- ` installation=will serve; _License #_ v2Z� Residence p I - ❑ A� artment House � Commercial. Trailer Court❑ on I .. ________________`___` - -g- _- ,.... Motel ❑ Other__-_ - -- -----:=_s • ; Number of living units:, ---- --------Nurriber.of.bedrooms,:- .•-_--_--Garbage Grinder-------------Lot'SizeWater Supply: Public S stemand a _- Character of soil to a depth of 3 feet; . Scrod � Silt y ❑ Peat ----Privat 1 .-.....,Har ; ❑ Sand L e ❑ "Fill M pan Adobe. If ye's, type-- ;y 'oam ]� :C y Loam ❑ - -------- p. (Plot plan, showing size of lot, focation'of-system-•inz-elation to-wells, buildings, etc, must be placed on reverse e NEW INSTALLATION: (No 'septic tankk or seepage pit s1de.J , permitted4if public sewer is available within 200 feet,] PAS KAGE TREATMENT Ca SEPTIC TANK [.] � _j , ( S1ze Liquid f pacity- -----`------ ------'Type- = `= = = Material = _Depth.' - �----------- Capacity -- q De th � R� ' --------- --No. Compartments -- ---- dWell.-___, ✓ --------- 1 -' 'f- ---Foundation----------- LEACHING LINE - �• � ° � � [. l No. 'of Lines F_ , = Prop. Line ------ --- - r -._., lstance:.to nearest: Box._-,-_._ ._ T e Fitter Ma' �y - ., .- Length.of each Tins._.:.-.------------ Total L ' i - a -ength ------- 'D' t T M, ----- --Depth Filter Material -___ -. Distance to-nearest: Well_---_--_-;,i't : - - ------ -- �- — . _ Foundation --= ---- ,- SEEPAGE PIT ! k. Property Line--' -------- Depth. Qiameter_` # = 'Number-__ ' 1 - --- R Water Table Depth-d,.----T-- ------------------- --- - - _ _ Ye ❑ N - --Rock Size, --------s Distance to nearest: Well's'`'"''_'-- t--_- --- '- _:- Foundation------------ o (Prev. Permit# - --------'---- * *----"-::Date Prop. Line ----- Se PAIR a DDSpONy equ Sements w, = --- ::Date------ ---------=--- - P ( p --------- ---- ' y ] , Dis sa Fiel {Specify Requirements]- �` ," _ x_�-f ------------ ----------- ---- -- --- -- i �- - C -- -- --------''---- ----- (Draw existing and required add(#ion on reverse side -- I hereby certify that 1 have prepared this"application and that the work will -be done in side') with San Joaquin Coup Ordinances,' State Laws, and Rules-and Regulations of the San Joaquin Local Health District. Home owner or licensed agents' signature certifies the following.' ts' A r� gents "1 certify that in the � .4 performance of the work for which this permit is issued, I shall not employ an to become subject to Workman's Compensation laws of -California." p y Y Person in such manner as Signed -------- �/ ,. - . Owner By �. - -- {lf other than'owner) _ � . - .�- � --- FOR.DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-_ :_.i-• _ DIVISION OF LAND NUMBER -_---_-------- • --- ----- - --- ----- ----- --�--- ----- -----DATE.., ----- --- ADDITIONAL COMMENTS- - -------------- ------- --- ----------------------- ------DATE- - i? ---------------- -- ------------------- Final Inspection by: _ _-__-, _ - ----w-++.n..r�.r. .. EH 13 24 - --- •- -- - ----_--_-_.�`�...."'--- ------ -- -- - -- ----- --ba �-- - -___ SAN JOAQUIN LOCAL HEALTH DISTRICT _ F&5 21677 REV. 7W