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FOR OFFICE USE: rf _ APPLICATION FOR SANITATION PERMIT . FOR OFFICE USE: . ----------------- ---------- ---- ----------------------- *� a.. (Complete in Triplicate) Permit No._Z -- Y ------------------ - ------------ ------ - This Permit Expires I Year From Date Issued Date issued__. ---------------- ------------- 7 p 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 Ordin ce N 549 and existing Rules and Regulations: JOB ADDRESS/LO ATION_..___"�J-- 40 �--f]_. - ------- --- ------- Address._ D ............ ---- - City. Phone-- . w . Contractor's Name = - - --= --- ------ License `- - Zip �- - .--�� Phone---4 �J---��/�� Installation will serve: Residence ❑ Apartmenf House.❑ :Commercial ❑ Trailer Court ❑ 4 Motel Other--.--- ----- ------ ------ , ,... 0 - >__ k r Number of living units:_- ."_-_ --_--,_Number of bedrooms---._ f ze-- ,t� ---:Garbage Gri der__.-----.-t'Lot.Size-_ -- �• ► Water Supply: Public System and.narrie__- ; ! �r "+ Character of soil to a depth of 3 feet: Sand Silt Cla ' � Private ❑ ❑ ❑ Y ❑ Peat�andy Loam ❑ Cla __ y Loam❑� `HaE]rdpan : Adobe ❑ FiII Material_ -__-If yes t YPe ----------------- € (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed n reverse side.) NEW INSTALLATION: {Noy septic tank :or see a e it s seepage' p permit ecl public sewer is available within 200 feet,) PACKAGE TREATMENT [ ] 'SEPTIC TANK [`� S. //aS�(q ,, ,/ fi Capacity-/l� 4 T ILP C ,,� ` ------- - -�---------Liquid Depth-._7__- YP. - - Material___ ___ a_ LEACHING L Distance to nearest: Well.;,- ys— Co, par pe f ._--___ o m /,66. --Foundation"- .,r Well--_/,66. - rop. Line d-- - i . { � INE- [; _ Na. of Lines------ ------------------`-----.tength of each line _-_-_�`ot v it al Length. Q--- --------- D' Box._--__-- -Type Filter Material"_ ---Ty 4 --------"Depth Filter Material-�-1_�_d_C f rr �Y fi C ] Depth-..-: t ----- ------ Q- ,�Q i ... 1 Proper"- ------ SEEPAGE PIT Distance to-nearest: Well 6a -------- --------- --- ---- " . Number--- . = i h- --- -- Rock Filled i Yes ❑ No iameter----------------- Numb Water Table Depth------- :------:--- , --------------- e_---------------- ..=----------- 4 ---•-- ---Rock Siz f Qistance to nearest: Well--.------------------------- REPAIR/ADDITION Prev. t _ Foundation'-----------------------`-.Prop. Line-------------- ----- ( 'Sanifiation Permit# :------Date-- --- Septic Tank (Specify Requirements)__------- __ fi --- ------------------------------- ----------------- Disposal ------- ---=- f -------------- Disposal Field (Specify Requirements)"_-__"-------- --- ----- - k ; _ - __-.___._"_-'________________ ___-------------------- ------------------ --------------------------- ______ _________ ..___-____-____.___ -_----------------- -- __ _________ _ ____--___ ----- - ----- --- _____-------------------------------- -_--_"_________ ---------------------_____---------_ _________________________________________________"____-___---___---_.--__-_-___----.--___--__-.-__--___--_.--__- (Draw existing and required additionon reverse side) r 1 hereby certify that 1 have prepared this application and that the-work will-be done in Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District,"Home owner accordance with San Joaquin Coun or licensed agent signature certifies the following: ?