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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT permit No: -" 3- 7b -----------•--------- ----------- i (Complete in Triplicate) ------------------ i Date Issued "" --- --• This Permit Expires 1 Year From Date issued R --- with County Di Ordinance No. 549 and existing Rules and Regulations: Application is hereby made to the San Joaquin Local Health District for a permit to construct and 'install the work herein PP application is made in compliance —�L described. This app ' -"_CENSUS TRACT ----- JOB ADDRESS/LOCATION "--- - Phone --------------------------•--------- Owner's Name ------- ----- - x'2----- �Q_�5 I r] - -----. City -- -Ire-�--�"��UI�------�i�.24F�-�-----�-� ----- -•-- � --- -- ' SUCH 7 --- Phone _`"-------------------------- Address -------------------- License # --------- -- ----- - Contractor's Name _----------- Trailer Court 'Dinstallation will serve: Residence [g Apartment House Commercial :❑ Motel [:]other -------------------------------------------- ----------- Garbage Grinder _:---------- Lot Size --------------------------------- Number of living units------------- Number of bedrooms ________""-• ----.---Private ❑ Water Supply: Public System and name _---------------------- peat El Sandy Loom ❑ Clay Loam ❑ Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Y e ---------------------------- ❑ Fill Material --____-_____ if es, Hardpan ❑ Adobe type buildings, etc. must be placed on reverse side.) (Piot plan, showing size of lot, location of system in relation e�m ttedof public sewer is available within 200 feet,) NEW INSTALLATION: (No septic.',tank or seepage p P -- SEPTIC TANK`[ ] Size------------------ --------- ----- ----- -------- Liquid Depth -------------------- PACKAGE ---- ----------•- 9 PACKAGE TREATMENT [ ] p ---------------------- Capacity -------------•------- 6 r� Ca acit ---------------- Type ------------- -- Material---------- ----- --- Na. Compartments PY - ----------- Distance to nearest: Well -----------------------•--•--- ---�-Foundation ------------------- -- Prop. Line --------------•----•-- 116 LEACHING LINE [ ) No. of Lines ___----- -------------- Length of each line---------- ---- Total length ----------- ---------------- ------- Length of each line LEACHING LINE No. of Lines ----------------- I -- ---- -----••---•-------- ` --------------------Depth Filter Material ------------------------- ----•------•------ 'D' Box -- --- Type Filter Material property Line -------- + --- Foundation ----------------- Distance to nearest: Well ""------ ------------ _ Rock Filled Yes ❑ No i❑ Depth _ Diameter Number ------------------------ SEEPAGE [ 1 = - -- Water Table Depth ------------- - ----•-----------Rock Size -------------------------------- -Foundation -------------------- Prop. Line ---------------•-----• S` FDistance to nearest: Well --------------------------------------- 1, Date - ) 00 > REPAIR/ADD{TION(Prev. Sanitation Permit# -•------- - -------------------------- _ -----A--------- ----- Septic Tank (Specify Requirements -------- ------------------------ ----- - Disposal Field (Specify eq uirements) ------------------------------- ---------------------- ------- ________________3___ ___-____ __-________ __ _ __-"_______ __"-__________---_-__-_____-__-_--_________-__-__-__-__-__-__-__-_--__ ________ "-""--- --- ----" t {Draw existing and required addition on reverse side) e in hereby certify that I have prepared this application and that teSa Joaquin Local°health District. Homewith owner or lcenn I he y County Ordinances, State Laws,'and Rules and Regulations oft e sed agents signature certifies the following: person in such manner "l certify that in the performance of the work for which this permit is issued, I shall not employ any as to become uble to orkm n's C mpensat{on la sof California." -- --- -- ------- --------- --- -------------------- Owner ---------------- -------- -- ----- Title ----------- ------------------------------------ --- -- --- ---- - --------------- ----------- (If other than owner) . FOR DEPARTMENT USE ONLY ---- DATE -----C'-- t�-_7.3--------------- APPLICATION ACCEPTED BY ------ ---- DATE .. -------------------------------- ----------------------- -------- ------•---- - - - - --- ------ ----- ---------- BUILDING PERMIT ISSUED -_---.- ------------------- -- ADDITIONAL COMMENTS ------------- ------------------ -------------------------- -------------------------------------------- - ---------- -------------------- --------------------- ---------------------- --- - -- -------------- - - ---- ------------ ------ ---- --- ----- ---.Date ---- ----- - Final Inspection by: ------------------ SAN ,fOAQUIN LOCAL HEALTH D RIC7 ,� o .'AA Rev. 5M