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FOR OFFICE USE: FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT l �]_ �T� Permit No----------------------- ------------------------------------------------------ (Complete in Triplicate) Date Issued.. ------------------------------- - ------- -------=- ----= ... l" _- 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: ------.CEN US - --- --- ----------------- S T Owner's JOB ADDRESS/LO - --------------------Phone.. w I T.. p ------- 1 ��' " Address-----_ Phone City. Zi i2�Zz one----- -- ----------- Contractor License # t 's Name.- -- _. Installation will.serve: rResidence Apartment House.❑ Commercial ❑ ,Trailer Court ❑ Motel .0 - 4-Other_. :=:-4_. ._L------------_.:. --- +- / Garbo F. Num ber.of living.units:------ _--. _Number of�bedr`ooms __ ge'Grinder__ ___ ` Lot Size_ Pr ------------ Wafter Supply: Public System and name .__ ` P • I .t �_. a Loam �i. Character of soil to a depth of 3 feet: Sand ❑ Silt-C] Clay.❑,4x7jPeat t Sandy=Loa ..60=�Ca Y El Hardpan [ Adobe Fill-Material --1f yes, type__.: ------------------ -- buildings, etc. must be placed on reverse side.] k (Plot plan, showing size of lot,.location of system in relation to,wells� �zY < NEW INSTALLATION: '(No septic tank or see ge pit permitted�jifll61ic sewer is available within 200 feet,] k � :� q�id Dep .__�"SEPTIC TANK [ ''Size_ PACKAGE TREATMENT [ ] • Cap?cit} __ Type __- -----Material__-- ---No: Compartrr.lents----'�--:-- ------ M - 3V\ Y .- _ Y/ f ! :Foundation-.=-----G40 Props I i�e__-.__ _ s Distance to-nearest:-Well .._--__.. ---- ------ LEACHING LINE; [_ No.'of Lines------------ ---- Length of each lin&...- --.--: - '�_----.Total Len gth.:__._la? 'D',Box-.-- TYPe Filter Materkal r Depth Filter Material ` . /. ._ } ] Distance to nearest: Well --- _Foundation_.-'-._-_ - Property Line --- iometer ----- - --Number-.----_----- Rock Filled Yes � Nor i SEPAGE PIT [ Depth ------ E' 1 4 i p Rock Size -------------- e Water Table'De th-- -- l Distanc; nearest: Well -� ----- - Foundation.._ .Prop. Line.----- ti -------------- ----- -- - ----------- ----------- ----------- ------- ' Date t REPAIR/ADDITION (Prev, Sanitation Permit#---------'--=---- - i - Septic.Tank (Specify Requirements)---_----------------- ----------------------------------------- Ii ------------------------- ---- -- „ .Disposal Field (Specify Requirements) -------- ------- --- ------------------------------- - f i -------------------------------------------------- ---------- -.-------.-.-"------------------------------------ - ------------------------ *_ _-_----.-------_-_--._-._--._-------_ --_ ----=------ -- -- _. d {Draw existing and required addition-on reverse side] i I hereby certify.that I 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 follow rill 111 certify that in the performance of the work for which this permit is issued, .I shall not employ any person in such manner 1qs to became .subject to Workman's mpensation,laws of California."" i t I Owear i Sign -- --------- ------------- - ! ed _ y - --- - Title -- .. r -�� ., - Ii BY -- I I (If other than owner) _ _ F DEPARTMENT"USE ONLY i.,. I , . DATE ------ -------- --- - APPLICATION ACCEPTED BY______I -'-" ------------ --------------- --- DATE DIVISION OF LAND NUMBER,------.---:-.--_----• _- -- p __ g4 .--- -- ADDITIONAL COMMENTS---- ------- --- ------ ------------------- - ---------:------------ i ------------------------------------------------------------------------ ------------------------- - - ---------------- ------ -- - -------- -- -=--------------------------- -------- ------------=---- --------- --- ---- -- , --------------------- pare ,-- Final Inspection by:_.. - T ----- - -------- -- F&5 21677 REV.7/76� N EH 13 24.{ SAN JOAQUIN LOCAL HEALTH DISTRICTI