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FOR OFFICE USE: FOR OFFICE USE: APPLICATION FOR SANITATION PERMITqq ---------------------------- -- --------- - Permit No�__r.-"-`-��-- (Complete in Triplicate) i n -------- - -------- ------------- - - Date lssved.5-�.�_."7. ----------------------------------------------__--------- 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: _y T .0 JOB ADDRESS/LOCATION v ....... = - .CEN TRA -_ S C -------I ------- Phone •37 Owner's Name._-tw---.----- , --- x. _ Address---------y7 . �- �.u-�--.�cr�� .._-,,.---- =City--- - �,.--------------------- --------------- P------ � ----- ---- r co, ntractors Name--- C' s ce .___ cu-1Q `� r License # � 7 /------Phone---`-- -.-j�'33--- i Installation will serve: Residence Apartment House 3.1 Commercial ❑ Trailer Court ❑ t ;.J: /, -- t-. a Motel ❑ Other. : ; j Number.of living units:_--/...-------Number of bedrooms_._ Garbage"Grinder Lot Size--------------------- �--------------- : ---- ,:. E, # - � ' -------- p � Water Supply: Public Systemand'name---- -------------------- � Privato ---:- - -F - ---- -- ---- ----------- -.- Character of soil to a depth of 3 feet: Sand ❑ Silt❑ 'Clay ❑ Peat Q Sandy Loam ❑ Clay Loam Hardpan ❑ Adobe ❑ Fill Materia L-A........'f yes;`ype___ ___________________________ s {Plot plan, showing size of lot, location of system in relation to�w.e'lls, buildintc.kmust be placed on reverse side.] NEW INSTALLATION:- "(N64_septic tank or seepage :pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT ['] ' SEPTIC TANK ['1 " Size___ --------- �' -----=-----------:------------=- -Liquid Depth------------------- --- L Material-- -- = - _..No: Compartments-- - --- . - Capacity - .. .'Distance.to..nearest. Well------------------� ---------------- LEACHING -- -- Faun"dation- Prop. Line. = '- 4 LEACHING LINE: [;] No. of Lines.._- :--- -_-._..Lengt,h of each' line._________________f__-- Total' Length._,.------------------------------------- .i D' Box__ __---- Type Filter Material------------------i--- " '--- _.Dept _FilteMaterial---�-------_-------A-.--------------------------------=. --------- Distanca to nearest. Well-]------------ % _ -----Foundation----------------------------.Property Line.--------- -------------...........{- -.-- . _ C SEEPAGE PIT [ l Depth-----------------Diameter_;_____.:_-:.__4I----Number!------------------------------- Rock Filled Yes ❑ No-E] i Water Table;Depth--"------- =`k x -_ Rock Size - Distarice;to'riearesf: Well_- -_.. }, -------','--'-..---'----Foundation------------------------- Prop. Line- --------------------- REPAIR/ADDITION (Prev:-Sanitation Permit#------=--=---- RDate--:-- ---- --- ------ Septic Tank (Specify Requirements)-- ---- ------------ --.--------- _---rt----------------------------------- -/---------'-_-----------='---- - - Y Requirements) r '�_' /A� " �� [P lei------------------------------ Disposal Field (S cif Re uirements :-- . ` �s - --- ---- -----------�--- r = ____ __ -=----------- ----------- ------- w t {Draw existing and required addition on reverse side] $, I hereby certify that i have prepared this application ond-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 following: "I certify that in the performance of the work for which this permit is issued, 1.shall not employ any person in such manner as to become subject.to Workman's!Compensation laws of California." i Signed = - ---------Owner 41 BY- =------ - - Title {1f other than owner) +... r . k :FOR DEPARTMENT USE ONLY { APPLICATION ACCEPTED ------------------------------- ----- = ---DATE : -------- ------ - ------------------------ -----------=------=--- ----------- ----- DATE-------- ------ ------- ------------ DIVISION OF LAND NUMBER -----------=---- -=-------------- --- --------: -- ., -- ADDITIONALCOMMENTS-..---------' ----------------- --------------------------------------------------------------;----- I------ --=---- -------------------=------------------- --- --- ---- ------------------------------------------- ---------- -- -------------------------- -------- ------------. ---------------- - ----- -: -- - -----Y--------------------------------- ------- - -------- -------------------------------------- -------------.------------------- --------------- Final Inspection•by= =� ``' y = �`_"� ------------------------------------------Date - r ------------------------- 1 - ------------------- EH l3 24 SAN JOAQUIN LOCAL HEALTH DISTRICT Fas s;b��izEv. rib 3M