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FOR-OFFICE USE: _ QP.,DF-FICE USE: APPLICATION FOR SANITATION PERMIT r � Permit No...7k"7J'-4- ------------------------ =plete in Triplicate]--t `-- ---------------------------- --------- --- - - Date Issued /--�-r--Tires 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. ith C city Ordinance No. 549 and existing Rules and Regulations: This application is made in compliance w _ r w � c ; � - -------------- -CENSUS TRACT--- ---- -- JOB ADDRESS/LOC 10N - s ` Phone - Owner's Na .!- --- -------- ---- - ��-_- ---- -..:. - :- --_. - ---- n..- - '- :- )City- Zip "� Address-: -- - .. _ .-_. -- '.'sem—�"-- -- �----- -. •. . _ - h . ,f�j _ Y i one Contractors Name L ---- --� _ License # � .5 3 P t ! - - a ;� I Installation ,will serve: ii, Residence Apartment House.❑ Commercial ❑ Trailer Court ❑ ----------------- - --- � --- •--- ----- ---- , / i �_ ar a e cinder_ =_Lott-Size _Q r-- Number of living units:- _L"_-:- ber of be oms g Num t t -- -------Private ❑ -. Water Supply: Public System and name - ------ ---------- - " �( Character of soil to a depth of 3 feet::. Sand ❑ Silt ❑ ,Clay ❑ Peat ❑ Sandy Loam ❑ € Clay Loam E] E ;Hardpan t Adobe Fill Material_.,:-'}.' _If yes, type---_"----- --------------- must ------------- �. P ❑', $ , i [Plot plan, showing size.of lot, location of system-in relation to wells, buildings, etc. must beplacedon reverse side.) NEW INSTALLATION: [No septic tank or seepage pit permitted if public sewer is available within 200 feet,) ri TREATMENT j ] SEPTIC TANK' ['] Size '_- '--------------------- PACKAGE -- -------Liquid Depth f E ' ...","_.r `No. Compartments----------------------------------- Capacity = =` TYP?= f. _ - - - - . -------- ' IDistance':to nearest: Wel :.-•_"--_ =Foundation" ° _- �.""- _ Prop. Line- Total- Length ---. -_-- - LEACHING LINE No. bf Lines ,- '-:- .:--- Length each line,--,", _ # -" -- g s� 1 Box--- '-Type Filter.Material Depth Filer !Material--- -_ --•---------------------------- D'a - 4 'Distance"to nearest-. Well :-_ Foundation -'__-- 3 _ --- ----Property Line ".-- '-- ------------------ ------------- :_ Rock Filled Yes No. SEEPAGE PIT [ l IDepth----=--- ---- -Diameter-=-----_-------------Number----------------- ❑ __ _ ----- :". :_ oundation" ---------------------- -------- Pr p Line --------------------- [Water Table Depth-- -__-- - _ Rock Size Distance to nearest: Well- ------- Prop. REPAIR/ADDITION (Prev. Sanitation Permit#--- ---- --=-----=---- ----- -------Date' ==' - --I------------------- -----r-j --�-- - Septic Tank (Specify Requirements)_ ------ -- - ------ Disposal Field (Specify Requirements),_,---_- /--------" ) � ' ---"---------------------------------------------------------- --f------------ -- - :---a -". -.-_._ ------ ---,-. -----, - --- -------"_ _-"• �___ r ° oi ----------- -"" ------------------------------------------------------- if that i have prepared thDSla'application and required addition'on reverse side) w I hereby certify t p p pp -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 becdome lett o Workmg Com ns', laws .of California." Sign �`�� i :Owner T T F Title_-_ ------ By .-- (If 'othei th .owner) j f, ...• .....,..---�� 'FOR'DEPARTMENT USE ONLY`"..""' - - - --_- ----------------- s - APPLICATION ACCEPTED BY_ -- ---------------- -k ---= ------ - DATE /�_A 7+fp DIVISION OF LAND NUMBER -------------------------- ° ---:.-'-.---------- DATE ; ADDITIONAL COMMENTS----------- ----- - - ----------- R ----------- =N - ------ ------------------------------•- -----_---- ---------------- 1 � '� - 2 ' '.-.. _y .................. - ------------------------------- !"i - - D -- --------------------- --- _ _ �_`_ r --------- ---- -------------------------------------------------- , Final Ins ection b __-- .. - = ate._ "��'' p Y, -- EH 13 24 SAN JOAQUIN LOCAL HEALTH DISTRICT F&s ztbrr Rev.��6 3M EH