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R FOR OFFICE USE: FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT --------------------------------------------------------- Permit r -• t•-a Permit No.__7f t~,[Complete m�Triplicate) �- --------------------------------------------------------- ! r . j . , ' Date Issued__�-,��___2_ ----- � ----------- --- ----------------------------------- 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/LOCATIO -- . -;_--=-a- -.-E- '``- Fy� , ------------.'C�� " TRACT5 Owner's Name.- F � -',/ /o J " Phone -------=--------- Address1�� - ----- !`K ' v C'ty zip- Contractor's Name_________ ___ _r! d__"__[_� -_______-_ _._--License # /S3 Phone _ft'S: Installation-will server Residence's Apartment Nouse El Commercial ❑e iTrai1er Court [j . �.: i .. r ... ) Motel ❑ Other----:---------- ------ -------- ------------- Number -----Number of living units:- ______Number of bedrooms—•J�___Garbage Grinnd'er1._=-_._____.Lor Size---- --—-----�: ___.___. € Water Supply. Public System and'name __--__ _.- C�i______cI• -_. ' Private F❑ € ,} _ Character of soil to a depth of 3 feet: r ;Sand 0 Silt❑ 'ClayI❑ Peat ❑ Sandy Loam ❑ Clay Loam ❑ s _Hard an Adobe gFill Material-- _-'..=-_.If es, type------------......I------ --- - (Plot plan, showing size of lot, location.of system in relation to wells, buildings, etc, must be placed on reverse side.) NEW INSTALLATION: ;.(N6=septic tank or seepage pit permitted if public sewer is available within 200 feet,) L/ / '� alb z 7 PACKAGE TREATMENT [ _] Sl=PT1C TANK W-00-11- Size--- 5-�`-- - - - ------ --------- --Liquid Depth.--------------.----------- / r. --------- Capacity'--/ Compartments fs1� Type = = --Materia --------- Compartments = Y v �._. Distance.to nearest: Well- ----- -------'---,---_,_Foun ation=-'.. a-------------Prop. Line--- ._--------------: LEACHING LINE [i]. No. 'of Lines-•{------ -------------- Length of each line-- -----•-----:- :-,_--•:Total,Length.?_-,---ea,-d---------------------- ;.D..'.Bo. x. . €, } ._ f _� - -r" --'____-- - - -- . ype .Det Fiter M - � Distanceto nearest: Well --FoundationPropLine rg�----------eESEEPAGE PIT - / �. Depth___-'-----------Diameter--------------------Number._ -----E------_ Rock Fiiled Yes ❑ No E]_ _ i Water Table•Depth �,: ------------------------ - Rock=Size _ __*, _ { i Distarice'to"Weare t: We11------- _ _ __ ti_ __=Found to ion._, Prop. Line REPAIR/ADDITION (Prev. Sanitation Permit#' ----------------=--------------Date------ -------------------------] Septic Tank (Specify Requirements)------ .. - ----------------- -- - =x ----- __ --------------i . ---- ----------------- --- Disposal Field'(Specify•Requirements)' • ------------------------ ----- ------------------------------ ------- __-----=-------k---- ____________ I _L -. .. _ _ ------ ----------- --------------- _ -- ___ ______ _____.___. _ _____________------_-------------------------- - _._-__-- __ ._ __ _-____- -__ __-___-___-______ ? (Draw existing"dnd required addition on reverse side) '`• �✓ I hereby-certify that J 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 of4the work for which this permit is'issued, 1 shall not employ any person in•sbch manner as to beta E m je s t to. an'sCompensation laws _of .California." I • 4 Signed-' Owner Byl ----'--------•-= fir, • --------Title - -' --- ---- i t 4 I ] {if ofher than'avu er) r 1,40R PiPARTMENT USE ONLY' APPLICATION ACCEPTED BY------ - " -- ----- =------- ------ ---- -- ------------DATE ------1 -�?-� - ty----------- DIVISION OF LAND NUMBER:------ - --------------------------------- ADDITIONAL COMMENTS- ---- ------------ -- ` - - " " ------------------------------------___ - -- -------------------------- ------------- -___-__-___-__--__-_.__ ___________________________'..__________ -__-_.i_� _-___ _ _____-_ --------- ___ _-4_____------------------------------------------------------ --------- ______-_-_ ___-________ ______-_-_.-_______._____ w y. Final Inspection by:_—_--__---------------------- s ...... , - Date -------- - -- --- ------------- --- --- -_�EH 13 24SAN JOAQUIN LOCAL HEALTH DISTRICT F8S 21677 REV, 7176 3M