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FOR OFFICE USE; FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT J Permit No. ------------------- ------- (Complete in Triplicate) Date --------------------------------------------------------- •-•----------------------------- ---------------__ -._._-__ Local Health District or a p n JThis Permit Expires 1 Year From Date Issued aaqu for to construct and install the work herein described Application is hereby made to the Sa . This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: CEN -------------- ------------ -- SUS-TRACT "�- # JOB ADDRESS/LOCATION" :- -- _ :. eQ �� r O --- _ l -- I Owner's Name..-------- - --------------------- s -- -City , -�..:------ Pli . }. ,...F. - - ------- Addressy--- ------- :.License #._ ' _ .. oneb 1-. Contractor s Name:' 9 _ Comm Trailer Court ❑ Installation will serve: Residence Q. p+�ar#Ment House ❑ al ❑ Motel.❑ -,Other= _ -- --- _ G - L ize Number of living urrits.�=l - Number of b clrooms -- arbage Grirldar . o S pnvat .- ._. �. - - -- } �, �. .. e Water Supply: Public System and name. -._ ------- y .� .. .. Sandy Loam ❑.Clay Loam ❑ t Character•of soil to a depth`of,3 feet;.; Sand :Silt❑ Clay ❑ .Peat{❑ � . — , Hardpan ❑ : Adobe Fill Maternal .. --:_-elf Yes, type_"E. n.' show size f=1ot location of-system in relation to wells, buildings, etc Fmust be.placed on reverse side.} (Plot pla �, 9 NEW INSTALLATIO[V: :(No septic tank or seepage" it permitted if public sewer is ova+lable`wifhin 2017 feet,} r--- i l yquid Depth SEPTIC TANK Size--------�------ l - k PACKAGE TREATMENT [ ] ; �i} -, 3 Capacity -1�0p Ype ; - .._Material- C '...NO. Compartments __:_:— OF i t� A .._Foundation..---1.i:1 ="__.Prop. Line.__ _ L c Distance-to nearest: - - , ... .,._. ..•..._.Q .. 'Length of ea. h,Ii l , , . , -.-,---_Total; lDr -- Total L�ength l s 1LEACHINGWiNo. ofLine , -= :- ---------------------------a .----.- �. � _ -- ate�id!_.- Depth Filter Mate ;D' Box.'.C�Type Filter MLina ----- ----;-�-�------ Property --._ Foundation Distance to nearest: Well ! i . Number . -- e N ❑ _ � �� r ' Rock Filled Y s� o SEEPAGE PIT [ ] ' .Depth ."1.Q --- Diameter.: _ `! r J! _ Rock Size__ - w Water Table Depth --4f -------------------- .� 0 = Foundation.__18�f" Proper Line `ice-------- -.---- ► Distance�to-•nearest:-Well "--- -- -- =:Date------------------------- ---=--- ----------- REPAIR/ADDITION ---------- a REPAIR/ADDITION{Prev. Sanitation Permit•#- ----------------------------------------- ----------------h ' _ QccQ' u �i_trr q.- -- Septic Tank {Specify'Requirements}- --- -.. . � � Disposal Field (Specify Requirements) ,---- k - ------------------------------- =- - ---------- -.- ------------------------y---- -------------- --------------------------------------- ------------- * . ------------------- . ----=......... -------''----------- ------------------------ - < = ----- .- `. (Draw�existirig and required_additi ' on reverse side] 1��+rctti sy ; I hereby certify that,) 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 fallowing: "1 certify that in"'the'performonce of the'work for which this permit is issued,' I shall not employ any person in such manner as to become subject to. Workman's. Compensation laws of California." ; - -------------------- -- ------Owner Signed -. ` ' ----� --=-- ---� -- ---- -�- -� .. +By - --------- �. t ( other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--- . ._- =---DATE.- -�--- �- -:----� ----------- �------- - ------ --- --- ---- --- DATE.:--- ------ -- ---------------------------- DIVISION ------- ----- --------� -- DIVISION OF LAND NUMBER.. = ---------- ADDITIONAL COMMENTS------------ ----- ------- ----------- ' ------- ---- -- --------------- ------------ -------------=-- ------------------- ------- ----------------------------- ---- ------------ - -------------------.---- --- . ----- ------ --------------------------- ------------- 1 --- -------- _ -- --Dat �- �--� --- - Final Ins ec#ion•b p Y'°--- '- -'--- f&5 21677 REV. 7/7b 3 1- SAN JOAQUIN LOCAL HEALTH DISTRICT EK 13 24