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y FOR OFFI� USE: FOR OFFICE USE: !F, 0/JP." APPLICATION FOR SANITATION PERMIT S ---- ---------------- ------------- - (Complete in Triplicate) Permit No..f_.__._ --_- Date lssued_�__5_-- This Permit Expires 1 Year From Date Issued 7� 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: JOB ADDRESS/LOCATION_.____ f - -- -T- T .. UQ.._..- /ZJ -U N -�-�r'---------- -- ----------:.-_.CENSUS..TRACTT-- ----------------- Owner's Name----- ---- , ------ 04* Phone_._T_� :> -. ---- r /�mac- _-::- _. J 1 ��^ .=---- Address---- (L�� iY1,C /vv ----------- ....... -- City------;^>7'V<.�e'7N- Zip ' . Contractor's Name--'-- '--------- ---- -- --=------- ----' ---- ------License # _ Phone' Installation will`sar3e: Residencex Apartment House.❑ Commercial ❑ Trailer Court ❑ Mote! E] 'Other Number of living.units:__- -�_-_�-NOHY6eof bedrooms_ :a �` k-_\ ^, � Garbage Grinder--- Lot Size............... i ._ ---- WaterWater Supply: Public System and name------------ . Private Character of soil to a depth of 3 feet: ` Sand ❑ Silt❑u Clay Peat❑ Scj ady Loam Clay Loam ❑ p I Hardpan E] Adobe ❑ Fill Material__.________If yes, type_ ____________- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) 0 NEW 7NSTALLATlON: (No septic-f ankpor seepage pif permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT j �/ [ ] _SEPTIC TANK �jQ e~��L✓{p _�� Z4gc �/Z_ A�E Liquid Depth------------------------ -------- - - Capacity-/ [0Ype iz ---Materia!-- ------------ ---- --No. Compartments-- ------ ---------- ---------- s Distance to nearest: Wei!_ ------.-----------Foundatiofl_ _FT-_Prop, Line.-#5 __ T-""_- LEACHING LINE -_ [ ] No. of Lines------ - =-- --_-------=-----.Length of each line..--------Q--�------------total Length ------- �--------- 1 Q' Box -..Type Filter Ma#ei ial_ DepthfFilter Mafieriai - , i ___. ? ' T Distance to nearest: Wel --- ___� � "!_-_..Foundation _.QST _____Property Line -. ,S- T" "" 1�,z•, I - f w..r. SEEPAGE PIT [ ] Depth -r __ __.Diameter__.------------------Number__ __- --- Rock Filled Yes ❑ No ❑ . . — .. ` { f , Water Fab!e,bepth -------------------------------- --- Rock-Size: ' } { # Distance to nearest: Well. --------- ------------ --- --Foundation '_.Prop. Line ' ;i --- REPAIR/ADDITION (Prev. Sanitation Permit#----------------- t___-.Date --------------------------------- _ . Septic Tank (Specify Requirements)__- ;< �` � '*- - - Disposal Field (Specify Requ.iiements)._� --" - } � ` w._ -- ------ ----- -- -,r: - - �. f --------- --- f ----=-------- --------- ----- - + .-, w�fes- .i "- ---- - .---- " " ------ ------------------ -------------=------------ ----------------- ----------------------- ---- (Draw existing and required addition an_reverse side) 1 g I hereby certify that I have prepared this application and that the work will be,.done in accordan�e`w.ith,San Joaquin Coun .. ._q� tY Ordinances, State Laws` 'and Rules"and�Regulations ofs'JI4 San Joaquin LocahHealth District, Home owner or Incensed agents signature certifies the"following:161 ce�ti that in the T –lis ;-�" � fY` peiforme�nce of a wore for whish this permit is issued, I shall not employ qny person tin such manner as to become subject.to .Workman' pe satio{i Idw" Californi6.'; "'/� ; Signed-------- Owner' - gY--------- = = ----- Title--- (If ------------------- T - (If other than";owner] r FOR DEPARTMENT US�='ONLY' ! APPLICATION ACCEPTED BY-=-------- - �= DATE.---- DIVISION - ------------ ------- - -- -- --------- OF LAND NUMBER.------ ---------- ------ --------------- -------.`' -------------- - DATE ADDITIONAL COMM ENTS---------------- c- ------------- ------- - ---------- --------------------------------- ----- -- c ------- --- --- ------ -------------------------------------- -- ---------- -------------------------- , -- --- --------------------------------- ------------------ -------------------------- ----------------------------------------- --------------------------------------- [f Final-Inspection by----- - ---------- = �- Date - /" ------ ----------------- ----- EH 13 24 SAN JOA UIN LOCAL HEALTH DISTRICT F&s 21677 RFV.7176 3M I