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j------FOR"OFFICE USE: t APPLICATA-JN FOR SANITATION PERMITPermit No.7.z=--�{•�-S----------- -- ---- {Complete in Triplicate) Date Issued--------- " This Permit Expires 1 Year from Date Issued --- --------------------- , Application is hereby made to the San Joaquin Local Health District for a pe ' to construct and install the work herein ulations: is made in compliance with County Ordinance No. 549 and existing Rules and Reg described. This app 'lication l CENSUS TRACT .�.5---� ------ JOB ADDRESS/LOCATION - _ - ---- --=-•- ----- -----------Phone ------------------------------------ Owner's -- ----- ----- -------------------- Owner's Name . . _ t------------------------------------ - � City � ---------•- ----- - ------ ---------------- ------------• Address10�._. �*S_ , t .. Phone ------- ----------- 5 --�-- ----- ----- ----- ------------------------------------ ----- ----- ----------- ----- -- --- -- License.#-Y =\. Contractor's Name ------------ — -� ..r—.--�-•-•Residence []Apartment kiouse•�❑--omrnerc�ialw❑Trailer-Court-,-�---•--��-�---- installation-will-server .� SIE. MotelCher --- ---- -----•- � a -------Garbage Grinder ------------ of +ze - ---------- ----- - --- - -- -, i Number of living units:_.._-�_.__. Number of bedroomsPrivate -------- Y ---- L—y"/ ----------------------------------- Water ------- Character of soil tola depth of 3f eetmeSand' Silt �.-. Cld Sandy soam Clay Loam ;❑ Water Supe y: --- ❑ _ "- 'Y ❑ Peat❑ s Adobe [I 'Fill Material ------------ if yes, type ------------ , Hardpan ❑ size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) i (Plot"plan, showing s l i NEW INSTALLATION: (No septic tank or seeps a pit permitted 'if public sewer is available Liquid2Deptht'---------- 4 SEPTIC TANK [ , s Size ----------•------------------------ --f--- - -- PACKAGE TREATMENT [ ] 44C_4 ` / rl�� No. Com artments -" --' Type o 4�--------- Material.C�2�� , P i ------- Capacity1 ;YP -------•- ; / /4 Pro Line ! Distance ito nearest: Well ----------------- ------------------Foundation --------- P s ` i i ' - Total Length 114119-- ' 1 /No. of Lines ._..2- ----------- Length of each line---------70- ---- LEACHING LINE [-T � • ;f _De th Filter Material ----- D' Bo -- ---- TYPe:.Filter Materiar' ------ P . } i ' t � i - � Property Line_ ..��---=--------- Distancelto nearest: Well -__ Q----------- Foundation - ---------- Rock Filled Yes ❑ No De th Qiamefie- ------- "Number ------ -------------- SEEPAGE PIT [ ] P t ---------- Rock Size ---------------------------•---- Water Table Depth ��..;.� :. Prop. Line --• 1 ---------------- -------------- L77 Foundation_---------------- -- Distance to nearest:Well -- :-- = Date ----------: --• ---- - - s REPAIR/ADDITION(Prev. SamtgtionfPermit# ------ �, ,' - - - ------- --- Septic Tank (Specify Requirements) ------------- ? . . , . - ------------------------------------------------- ----------------------- ------------ - Disposal Field (SpY'Requiremen s [ - -----__-• = t f-- ----------------------------------- .. --------------------------------------------------- -------------------- - .. -------- ------"-;_ * { (Draw'existing and required addition on`ree 11 rsseesi done-in-a) ein-accordance-with San Joaquin I hereby certify that 1 have prepared this application and that the work County Ordinances, State Laws.' and Rules and Regulations of the San Joaquin Local Health District. Home owner or.licen- sed agents signature certifies the following:.•- -•-r1 r,on in such manner "I certify that in the performance the work.for,wltich this permit is issued, 1 shall not employ any'p� as to beco subject to Workm 's Compensation laws of California." 1 Signed - Title -------------- -------------------- J� ,WOwner -------- --------- ------------------- ----------------------- (lf other than owner] ` 1 FOR DEPARTMENT USE ONLY DATE ._'r� --------- ----------------------------- -------------------- DATE; ..------------------ - APPLICATION ACCEPTED BY _----- ------ .- BUILDING PERMIT ISSUED ------- ------ -----------•------- MMENTS ------- A---D--DITION AL CO ----------- ---------- -----------------_------------------------------------------------- ------------ ---------------- -- -. - _-- - - -----=---•---- I1._37-z ------- ----------------------------------------------- - - - -------------- ---- ------ ----- -•--- -- -- ------ ----- --- - - -- Fina6 Inspection b -------------- - - -- --------------------------------- Date ' .w SAN JOAQUIN LOCAL HEALTH DISTRICT F c u 0 -1-%A8 Rev.'5M