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FOR OFFICE USE: FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT (Complete in Triplicate) Permit ............... . ...... --- ... . .......... - ---------------- -------..................... This Permit Expires 1 Year From Date Issued Date Issued/.;! /. .. ?_8 Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein describe This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION... 7,-��;y,... ......-„--.-- _ �:Z T�� - --- . .:.-..CEN TRAC Owner's Name.:....,ll.-/. ... : . :. --.. . _. ....-- hone...305; Address------..o ; - License #- 4.d.7.2/,_..Phone-_ SP. : Contractor's Name.. --- ' .f�.. GXo L� - Installation will serve: Residence❑• Apartment Ho6se4l �Co�m'Trailer Court ❑ c• 41 Motel p Other-- , . _ . i Number•of living units:_.... p .....Numberbf.bedrooms .3...`: ._.Garbdge Grinder..........-Aot Size.___. �.az-ea '� ----------_. - ------- Walter Supply: Public System and name..__: --...... ......... ........ .: ..•... ----• -----Private Character of soil to a depth of 3 feet: Sand ❑ -Silt❑ Clay❑ . Peat ❑ Sandy Loam j� Clay Loam ❑ fiardpari❑ . -Adobe "' ' I ❑ Fill Material.....: -..If yes, type.- 3V -t ....... (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc.must be placed on reverse side.) t NEW INSTALLATION- '(No'septic tank or seepage-pit permitted if public sewer is available within 200 feet,) t PACKAGE'TREATMENT”[ j'•'-SEPTICTANK '[c}--�— T -Sit{e{...�o.e��P.k.l�lZa.��:,--- a-Liquid Depth..Z_>.A0... ....... 1 cap aciry.e.,.�//ve�...::.,Type... * :_Ii_:_Material.t.��rV..:..'.:rreTl.o-Co patmeiit`i..: .. Distance fo nearest: Well.:....:. ........4.:.........._...,...,Foundation.s� ._..... ....Pro • Line........_............... R' r LEACHING LINE;: [-r._No. of Lines.:...... �...._�_.__-14hgth o each line.. , 1---,tOotal Length. ,,..y'S�_-_, i r _ 'D' Box--z .......Type Filter Material .li.!r� �$epth Filter Matenal ..`._ _............: .......... .--.-_-__ i „T_ o- t su ,,ip Distance to nearest: Well-,---,17' Foundation ....9 .......--.property Lfne..e �"_� ........_. r. >e /55�/�,,, t XiPfcPi-PFf {�) Depfh..� _.....9 emAtea. ......:....:..Number...,..._�—./ , Rock Filled Yes (�.N� • [Water To Depth....... ®.J-......----...................-'--..Rock-ike, .................... , �•�-.......p.. / Disfance'to --,._...Found tion:: l...0 ......Prop. Line....-;;-. ........ REPAIR/ADDITION (Prev. Sanitation Permit#.".::::T.____ ..... Date.......................... .. r Septic Tank (Specify Requirements)..._:.....:! r s. Disposal Field (Specify Requirements)..--•- ------. - -- _-----:...---------•--•----- ..........-•------ -----... t ...........................i............. ........ -------------------- _ ___________ _____............................ (Draw existing dnd required addition on reverse side)j- fK. —•- I hereby certify that I have prepared this application and that'the work will- be done Ilm accordance with San Joaquin Coun Ordinances, State Laws, and Rules and Regulations of the. San Joaquin Local Health District: Home owner or licensed ager signature certifies the following: i "I certify that in the performance of the work for which this permit is issued, 1 shall not employ any person in such manner to become subject to Workma Compensation laws of California.".. p Signed ...... . . ...............*thv _ Owner [yd i - _. ----- P`. . By. .......... ---- T tie .. . (If othrier) ` "" f t " 011!DEPARTMENT USE ONLY'- ? t_ _ 1 APPLICATION ACCEPTED BY:......G - .:.: -..._:.,.. =- ......DATE ll� 0- .. .:._...:... DIVISION OF LAND NUMBER — +-: . ...... ... ......... ------ .................,................. ..DATE........:.............. - ------' ADDITIONAL COMMENTS--.....................-----:....... ---• .....:......:_.-...;.._.,................................. - - - -- - .. --------------7........................................ `. --------=--- -------..:......----...:.................................... -- --=......................... ._.._._.._............ a 1 -- --------------------•--- ------................ Final inspection•b :.-.... . -- --- -- ----------------------_-------------- ............................. . .. ......,....: 1/�� )y . ............ Date...,l.�.:-1......"�.-- -•--.....--- - EH 13 24 SAN JOAQUIN LOCAL HEALTH DISTRICT Fes 21677 Rev.7176