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FOR OFFICE USE: FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ----------------------------- ----- f �I (Complete in Triplicate) Permit No.7F�-_7,57.__ ------------------------ -------------------------- - I� Date Issued__Y__4--_28' ________________________________________________________ This Permit Expires 1 Year From Date Issued :I � I 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._.- I�6 _ y vlc- s--------------------------------- CEN US TRA ------------ --------- _- - ---------- -- � --- , T Owner's Name. �; :.- _ _ ------_ ----------------------------------------------- :----Phone__ = ;7._._ A*C - [I'[ ; - ----City- --- ---- --- ----- ---- Zip----------------------------- Addresss_C t� Contractor's Name._____ _.___! � /`��--�- ----�- -=---------------- -=- -- -License # -- ---a..-�_�______----Phone-;5 -- --- - --- Installation will serf- Residence Apartment House.❑ Commercial ❑ Trailer Court ❑ + : . . :� otel ❑ Other -------------------`---- :_...._; .. � . _ Number of living units.__l-----------1iqumber.of,bedrooms ,;`-____Garbage Grinde.r__:______------------- - _- _ _ _________________ ' i I - Ip} Water Supply: Public System and:name ` - '._ :: -.:,_.--:- - --- Private, l Character of soil to a depth of 3`eet: - Sand ❑ Silt L] 'Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam x Hardpan ❑ Adobe❑ Fill Material_...-----_-_Jf yes, type-------------------------------- (Plot ----------------------- ------(Plot plan, showing size of lot, location of system in relation to wells, buildings,'etc.'must be.,placed on reverse side.) � d NEW INSTALLATION: - (No. septic tank$or-seepage pit-per`mltteEl;tf public sewer is available within 200 feet,} t PACKAGE TREATMENT [ ] SEPTIC TANK ! "" "'_______Liquid Depth._____.__------------------ ;I -___._ ._ [ l Size - -` ----------------- Capacity--------- --- --`Type=---- ----------------Material----------------------------No, Compartments ---------- i, - 4/ - - 'Distance to nearest: Well_.----------- Foundation---- ----------------------Prop. Line----- !I_------------- � LEACHING LINE [;] No, of Lines _=-_- -__�T Length of each.line e Depth Filter Material Total Length ---------- _I _------ ''D' Boxy Type'Filter Mdterial-- p -------------------- ( �. .I- - ,e s ..t.- r. �,___ ___________ Distance.to nearest: Weil___-_-'____--_-,._____,____.Foundation____ ______ ______ __..Property Line._`------------I_ SEEPAGE PIT [ ] Depth____ _ ---------Dia meter_--- - -R Number-----______________.___ ______=_ Rock Filled .(Yes!❑ ' No ❑ ! Water Table Depth------------------------------�'------------- -- ---Rock Sizer----- - , j Distance to nearest: Well---------------- ---------------------------Foundation---------:------ ------.Prop. Line---------------------------. REPAIR/ADDITION [Prev. Sanitation Permit#- -----'-----__-_ -__ ::.Date----------------------------------------- ----- -] Septic Tank [Specify Requirerrlents]----- --------------------------------- -- --------------------------------------------------------=-----=---=-----------=------------------I---z-------------------------------i-------..-------- Disposal Field (Specify Requirements):--- �.-�"7� -- , -- - --------- -------------- --------------��` . lo ------------------ ------------------ --------- ------------- - - -------------- ------ - - _ . ------------ d - xi`sfin` a� �-- }----_ ---------------------------------------------------------------------------------------------------------------------------------------------------------------=----------- ------ {Draw.e g rid,required addition on''reverse side] i I hereby certify that:( have prepared this application-and #ha t e ;work-wiil"be' done in accordance with San Joaquin County Ordinances, State Laws, and Rules andRegulations ftlin Joaquin Local•. Health District. Home owner or licensed agents signature certifies the following "I certify that in the performance of'the..worR .;' ich^,this perinWis-issued, I'shalh not employ 'any person in'such manner as to become ubje to orkm Compensation► laws of. California."__ f i Sighed. r f1- --- � - - .. -- . ...i -� 4 :_ j Owner «. - . �s v4_ f�: B i tl ` ► , .Ttefl 3 -- t i { , [ ��(If other'than owner] -' -_a F . :tel FOR DPA MENT USE ONLY, „E __DATE.- - -=-----`-3�--Z- . APPLICATION ACCEPTED�•BY�_ - - -- _ .________________ DIVISION OF LAND NUMBER - - - -- :. DATE----------------------------- -- ---------- OF - -- - --_ ---- - - 3 -------------- --------------------------�M------ -------- ---1-------- --- - ----- ------------------------------------------------------------ Final Inspection by:--.-sem ------ = ----------- Date.-- ---��--- EH 13 24 SAN JOAQUIN LOCAL HEALTH DISTRICT ras 21677 REV, 7176 3nh M, i