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FOR OFFICE USE: ✓``�' APPLICATION FOR SANITATION PERMITr i FOR OFFICE USE: (Complete in Triplicate) "', i, Permit No----- �%__: 9a Date Issued._.----- ---------- --------------------------------------- 7:_-------"----------------------------------- ------- ------- 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 here. s ed. This application is made in compliance with County Ordinance No. 549 and ekisting Rules and Re u! r JOB ADDRESS LOCATI 170 co _ ./. O "- :� - - r CENS � Owner's Name-=-- � ----; - - - -------- --- ---- --------- ------------- ------ AdPhone dress-----------------— -574 ` c� _ _- ,�J l _ City.... ---zip------------------------ Contractor's Name------- ----_ --e * License #.3�-!p - -� -� -- Phone------ .. _. _,. .,• .. � _. -- Installation will serve: Residence fir' `\` I [ Apartment House' Commercial-[]' Trailer Court 0 . .Motel 0.. Number.of living units:-------- _ __Number of bedroorris-l___?_Garbage Grinder _ Lot Size_________________ ' I ---- ------ Water Supply. Public System`and name----'--- ---_--=- --;:-.:---; _... ---------- Chbracter of soil to a depth of 3 feet: Sand 5iR - -` Private Hard an-f� Adobe n Fill Material--__'------ yes, type..._ -" ❑ .. Clay Loom ❑ ❑ ❑ ; Clay ❑ Peat ❑ Sandy Loam P (Plot plan, showing size of lot, location of system in relation to•wells, buildings, etc. must be placed.q.n reverse side:) NEW INSTALLATION: [No septic tank:or`seepage piff permitted if public sewer is available within 200 feet,) l PACKAGE TREATMENT"j ) . SEPTIC TANKr d-- Size = _ - - Liquid De � pth _ - """-- Ca p Capacity — __. _.. . P Y FyPe.--:/. --- ------------Material _;No. Compartments = _.. : ---I = Distance to nearest:"Well-- _.-------------------- Foundation_______________ __ _____ Q LEACHING LINE [ ) No.'of Lines--------------------------- Length of each line Total Length --P.-.,:--- ro Lifie 5 - - ; 0 D' Box.___. _:_'Type Filter Material__.______"�V__-De th Filter Material__`-__.____ __ _ p - --- - i Distance to nearest:4 - Well - ----------------------- ----Foundation------------- ---:- Property Lin __'7=-----""__-- ---------- � SEEPAGE PIT Depth---------- -----Diamefier----_------ - ; . .. . . - — --- __ ------------------ Rock Filled Yes ❑ No Water Table Depth----- ---------------- Rack Size ------------------------------ REPAIR/ADDITION Prev. Sanitation Permit#--------------•------•--•-----=--_":--- -__ Date:.-:_._ -' Prop. Line--------------------------- - istance'to nearest: Well._.."--.__...._____"--:_-__ "__-__---_-_-Foundation Septic Tank [Specify Requirements}---- .._---_-_ ----------------------------=--------- --------=--------------- Disposal Field (Specify Requirements).-_.._ cC"." �Y - � •, Z ----- - --- --- - �' �r - (Draw existing and required addition on reverse side)' I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District, Home owner or licensed agents signature certifies the following: "I certify that in the performance of the work for which this permit is issued, I shall not employ 'any person in such manner as- to become subject to Workman's Compensation laws of California.". Signed = -------Owner By-------------------------------------------------- Title-- •------.---- - (if other than owners FOR DEPARTM T USE ONLY APPLICATION ACCEPTED BY__- _ ---- DATE._--- 13 .7. DIVISION OF LAND NUMBER -------- --------------------------- DATE. -- - ADDITIONAL COMMENTS---- -----_ ---------------------------------- -------------------------•---------------------------------•-------•---- --•----------------•---- •----=----r V --; -- ----- ----------------------------- Final ------ .---------- ---- --------------------------------------------- --- ------------------------ - - -- - -- - --- ---- ------------- Final Inspection by:_. - -� =Date. _ EH 13 24 SAN OAQUIN LOCAL HEALTH DISTRICT d 21677 REV.7176 3M