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r' o- " FOk OFFICE USE: APPLICATION FOR SANITATION PERMIT �_ Permit No. .:.... ....... ...... . (Complete in Triplicate) r 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:-: JOB ADDRESS/LOCATION. 43 1 40..,-.� -..�� 'r._............. CENSUS TRACT . Owner's Name ..........................Phone ........>.............T...T.... f� �/� � ��p p�.� Address . ..........d�v (o.;. LGE.r Q.asea. � G uQ �....... r�.. ..City ��..,� �� ..................................... t ...................."..btenje #a�.S`><:Rll-3 — P_hone.y7�?�?>::?40g7.:.: Contractor's Name ._.... .. .........._. .. . , i Installation will serve: Residence ❑ Apartment House Q Coimmerci a1-j]TrailerCourt _ice." _ T n/J - 4 n �—. \ Motel ❑Other ..Re4t.C�a�.Py1 _ r r Number of living units:.. ...:..... Number of bedrooms ............Gama eGrinder ............ Lot Size .......... Number 9 i Water Supply: Public System and name ._................... ..............................................;....tu...,....., F Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay loam Hardpan E] Adobe ❑ Fill Material ............ If yes,type ............. .............. (Plot plan, showing size of lot, location of system in relationito wells, buildings, etc, must be placed on reverse side. NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewerlis available within 200 feet,) I i PACKAGE TREATMENT [ I SEPTIC TANKPQ p Size....�.�_..X.�................... ........ liquid Depth ....... r � rial..(tB'k�... . No.rCompartments ........Capacity 00f0f. Type 14� .-- Mate Distance .... to nearest: Well �p0...1.;2`..............Found tion....,lQ..y`...... Prop. line ..._ ` I i LEACHING LINE No: of lines . �f) ... i en gth loaf/each line _../�. ..._ ` .... Total length .. _............. ' ✓ TF' V ; + 1� � ----Depth `Filter Material ....._11r.-��-.......------------- 111 D' Box .to nearest: t alter MAaten . Foundation ... ..D.-]�'........ Property Line ...4_t..... SEEPAGE PIT �Q Depth Distance Seores6 .Wf Diameter 33'......... Number . .....: ....... Rock Filled Yes ".No C l Water Table Depth ...�............. .._�. .... ....... .-RocvS:ze .�.�y.....�..rf`��..... Distance to nearest: Well ......nk O . ..Foundation 3: .._ ..... Prop. Line .................... I`..............+.. REPAIR/ADDITION,(Prev. Sanitation Permit# .. ............�.......................f.. Date .._ ------ -- I I Septic Tank (Specify Requirements) _._.. -.-..,� � - � - e Disposal Field (Specify Requirements) - - --- n .-......_..:............................. ......... ._.. 11 .........-.......---..-... ... . ............... .. ............... .,....,...........................__......__. .......-�T........_..--_................................_-..... . ............................ .. ................................. o IDrdw existinand required addition on reverie side)? I hereby_certify.fhaf_I. have prepared this apph�ation and that the work will be done in accordance with San Joaqui County Ordinances, Slate Laws, and Rules and Regulations of the San Joaquin`local H o1jW 5isfifcff Home owner or Jiaf sed agents signature certifies the following: / "I certify that in the performance of the work for. c this p ermit-is issued, I shoWnot`employ onylperson in such mono 1 as to become subject I'o W�-Croftip-�*n1ation laws of California.," T -- Signed .... ...... ........: - ... - - -----..........._...__.,bwaer f+ : ._ Title • � ..- �;(If;or an owner) I -; tFtLJ `J VD TMEJ•ITvUSE ONLY APPLICATION ACCEPTED BY ... -. .. .. �:. DATE . 3��1� - ....... BUILDING, PERMIT ISSUED'........ .... .......% ... . .. . ....... .. .... . .. ...... ...... DATE __ . ..... ...... ....... ADDITIONAL COMMENTS't..... - - - ✓ •` .... ............. .................e... _... . - ..i......_...._+ ................... _ ......... ............._.._.. - � ote .... ...... Final Inspectionby: ., ................................... OAgWN LOCAL HEALTH DISTRICT