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6-/t-7' T FOR OFFICE USE: FOR OFFICE USE: N APPLICATION FOR SANITATION PERMIT ..-----". -"- --"""_ Permit ------ (Complete in Triplicate) _ r Date Issued._/`1F�--fid _-"-"".. t This Permit Expires 1 Year From Date Issued > Application is hereby made to the San Joaquin Local Healthfor. �-permit to co DestriNot549 and exist ng Rultwork herein described. es and Regulations: OB ADDRESS/LOCATION...._ -" This application is made in compliance with County 7 -"•- ------.CENSUS TRACT......:....... J - Phone..... ----"- Owner's Name..... " ........ .".:............."--City.-. 3 � � Z i�P-- ----- ------ Address --- Address----- _..... _..._.. . License Phone -� - �-��- -- - - Contractor's Name" Installation will serve: Residence Apartment House [:1 Commercial F-1 Trailer Court [IMotel ❑ Other... _----"- Number of living units:."."I"---------Number of bedrooms_._. `.-Garbage Grinder............Lot Size---- ._. _ privateA Water Supply: Public System and name------ ---------------- - Peat at ❑ Sand Y Cla Loam ❑ Y Loa Silt Cla Character of soil to a depth of 3 feet: Sand El Silt Y ❑ 1 If es, type--- •------- -- Hardpan ❑ Adobe ❑ Fill Material,- -.: .. y {Plot plan, showing size of lot, locationlof system in relation'tb wells, buildings, etc. must be placed on reverse side.] NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,l t I Y / �/ / Liquid Depth._ . SEPTIC TAMC: 13 Size... .�X._4f "- " "- "- - PACKAGE TREATMENT [ ] t ,Q .- ""Mate,r'sal_� ---No. Compartments-.-._�--------------------� Capacity-/ .TYhe.--�'r✓ r7� -"..... ...... ..-. t t � :-.r--=----Foundation.."-- Prop. Line----...- . - -- . .. .. Distance to nearest: Well�:- -�-Q J ' Total Length . !-%:�---".----". LEACHING LINE [ ] No. of Lines ._`�'J-- ------- • '--.Length of each line.--"- -�--- t �1 'D' Box.. ...-.. ..Type Filter Material--- Depth Filter Material - --- .. D Distance to nearest: Well---'/' Foundation.-------" - Er.operty.Line--„” :,-, - R k Filled Yes No SEEPAGE PIT Depth.. . . ..Number-- - .__._.--•- -- / Water Table Depth.._.....__." -•-- •Rock Size I / t . Distance to nearest: Well..... ----- -Foundation----.-.... -- �- -.Prop. Line.. ----- ..... ........ .. b REPAIR/ADDITION (Prev. Sanitation Permit#i___-._"_" -- -----.Date----- -• ------- ------- ------------"-) -"._. ---•----------- ----•--- "- "------" -- " # Septic Tank (Specify Requirements .... fi . -" Disposal Field (Specify Requirements -----_------ ---= ---- ........ --------- -- - - (Draw existing and required addition on revers e side) I hereby certify that I have prepared this application and that the k wowlddone accordance ct. rJoaunou Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local � DistHome owner oragents signature certifies the following: 1 � "} certify that in the performance of the work for which this permit is issued, 1 shall not employ any person in such manner a I to become subject to Workman's Co ensaticm laws of California." ! n er Signed_"-- - ..... ....... ... .... . .--- .. Title... _. ... "- -- -----" ..... --... ........... ` [l athe tan owner] s F R DEP A TMENT USE ONLY U DATE APPLICATION ACCEPTED BY_--- _.. ---- OF ..... ..........." --.DATE:---" ""-[--" ls1�-. -.7""--_-".�.----.".-�.-. - ..-. - - DF LAND NUMBR-------------". --... ------"" " -- ._.._.. . " --- . • .DIVISION ------ k ADDITIONAL COMMENTS.- "----- ---"-..- ----------- ...... lr�T -------------------------------------------- " C _--- - Final Inspection b -- -- 7�"" F&S 21677 REV. 7176 3N y.....". ---------"- " -- EH 13 24 SAN JOAQUIN LOCAL HEALTH DISTRICT