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FOR OFFICE USE: FOR OFNCf USt: APPLICATION FOR SANITATION PERMIT (Complete in Triplicate) Permit ------------------------------- - --.--- -.--- ------ ...• .................... ............. This Permit Expires I Year From Date Issued Date 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/LOCAfiON....__ ...._.. .-jt*AM,F_ -_ AD .._.-1-0b.j-•---CAS.__.CENSUS TRA Owner's Name d.Wr ILI! -.. ....��L� K<<r a _ D. .. ...................._.\. ......Phone - --- :"�Q. ��........ Address....-- _S.- fH�- -------------- Contractor's ------------ 'ETf,➢ 4 .3© - --.. Contractor's Name ---- -� ------ -- ......License #............. .... ... Phone---_...: Installation will serve: Residence% Apartment House ❑ Commercial ❑ Trailer Co rt ❑ Motel ❑ Other_ --- -------------- ------ $ Number of living units:-----.. ._-._Numbe of bedrooms...3....Garbage Grinder------------Lot Size __-�). �5 Water Supply; Public System and name.: .__ -- ------------------Private Character of soil to a depth of 3 feet: Sand Silt❑ Clay ❑ Peat ❑ Sandy Lou' Clay Loam ❑ Hardpan-❑----Adobe Fill Material !# yes, type--,. (Plot plan, showing size of lot, location o em i'n. relation to wells, buildings, etc.. usf be placed on reverse side.) NEW INSTALLATION: JNo septic tank or see pit permitted if public sew/eis available within 200 feet,} PACKAGE TREATMENT [ j SEPTIC TANK5ize..... ................. . __. Liquid Depth. - �. ------ Capacity 1�.Q0.� - --.....-..Mate�riaf-.�..'---:--.-__.No. Compartments_...----'�-....---.......------� l t - Distance to nearest: Well-.-----._.�. .. ........ .............. .oundation.._._-1�..-.-.......Prop. Line... LEACHING LINE .1 [ ] No. of Lines .-_ � - - - - Length o each line. -__-..- 85_-..-------. Total Length ._ .----�,•�S'---:--- ---------- D' Box_. .T�e filter Material_ :y_ PSD th Filter Material._ ...t .... X . ......., =--s-. Distance to neare . Well----.-- d '.......Fou dation..... -----------------------Property Line ' ---------- SEEPAGE PIT ( ] Depth........... ._ is eter....................Numbe -- Rock Filled Yes ❑ No❑ f Water Table th -------------------- - ....... ----•- --Rock Size.. - ................................ Distance to nearest: Well--------------- ------- -• ................Fo ndation----- ..............Prop. Line . ........ REPAIR/ADDITION (Prev. Sanitation Permit#......_--_----- . ...............Date-- -------------- ....------- # Septic Tank (Specify Requirementsl--------- -------•- - Disposal Field (Specify Requirements)........ ............ = ------ --------- - - ----- ------------ ------- ----- -------- ------------- . - -- ---------- ._ ------------ --------- - ---------------------- ---------- {. Draw e'xisting a d required addition on reverse side) � I hereby certify that I have prepared this application nd that the work will be Clone in acc r.dance. with San Joaquin County Ordinances, State Laws, and Rules and Regulatio.s of the San Joaquin Local Health Distric Home owner or licensed agents signature certifies the following: "I cerci hat in th p once of the work for.which this permit is issued, 1 shall not employ an,y person in such manner as to become bject man's Compensati laws of California." Signed- ---..... - -- -------------- ..........Owner BY•-------•---------- -- --------------------- ------------- - -------..........-Title---._...-- ----------- ---- (If other than owner) I. f9t DEPAftTMENT USE OtOLY APPLICATION ACCEPTED BY--------- A� DATE _... DIVISION OF LAND NUMBER'------- DATE i ------- --------- -- ADDITIONAL COMMENTS... ---- -- -------- ------ ---- -- --- - r -- ------------- .._------- `� ---- ....---- - _.. Final-Inspection b ...........-Date.. . .... Y EH 13 24 JOAQUIN OCAL HEALTH DISTRICT F&s21� 7176 3M