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FOR OFFICE USE: FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT r --------------------------------------------------------- � o (Complete in Triplicate) t Permit No._ _ _:____.,,•---------- ,,?I Iss ate _.____.__Date lsued_. .T _________________________________________________________ This Permit Expires 1 Year From Date Issued � Application is hereby made to the San Joaquin Local Health District for a permit to construct-rind install the work herein described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: } ! _ . _ . }v t JOB ADDRESS/LOCATION lJ `�J. ._.. _. - :- __< 1 %�'[EN U TRACT a, _ , 1 ) _• - Phane._ -O- Jr Owners Name.------- --- c. - ) ---- �--------.----------------- --------------------- C7i/ -- 1 := R-- . - --- i /y) pS`3 6 Address fi Cit . i Zi 1 ' Contractor's Name--------- Y-C- --- ---------------- - --.----Lice se•#-------- -------------------Phone------ #------------- Installation;will serve. ` Residences Apartment House':E]4 Commercial ❑ Trailer Court ❑ !, t. .. Motel ❑ O e - , Number of,living units:_ �_ _-Number.of.bedrooms___-__ _-_:_Garbgge Grinder.-:_..t-1 Lot Size...... .-- ---------- --- r :-- ----------``- --------- ..�:� - _ ---- I ---- --------Private'Water Supply: Public System and name__ __.= __ Character of soil to a depth of 3 feet: Sand ❑ Silt❑ :Clay ❑ Peat❑ Sand; Loam K 'ClaySLoam [],Adobe„,,,. -------- �❑ ] Hardpan Adobe ❑ Fill Material--.-- ......If yes,types !--1.--____- ��t (Plot plan, showing size of lot,'location'of,„system in relation tovells, buildings,,etc.rmust be placed on reverse dey.).M„ti.' N NEW INSTALLATION:” (No septic tank -or seepage~pit permitted i#upublic sewer.is available,within•200,feet, PACKAGE TREATMENT-[-]-+SEPTIC•TANK—[fl' * Size______ ---..----Liquid Depth._- _ - i Ca acit --------Te.------ ----- ------_Material--- --------No. Com artmenJ--- g.•- f. Distance.to nearest: Well:;- __ - -_.... -Foundation------------------------- ---Prop: Line-------- ---- ------.. r ---- V LEACHING LINE, [j No. of Lines-- --_ Length of each Iins. ___ ______________Total Length --_-------------------------------- L _.,______.__ .___.h__ ` D' Box-----------.Type Filter Material--------------------Depth Filter Material----------------- _ -- ------------------------ s Distance to nearest: Wel! -- _Founda ion-----------------------------Property Line __.---------------------._ _ SEEPAGE PIT [ ] Depth....:... .....Diameter ._.-- .-.--.-..Number - - . ---------. Rock Filled Yes E] No E]p_ Water Table Depth----7 - +�Rock Size = - ----- - --- �' Distance to nearest: WeII ------ ----- t Founcl�on-------- ------------ Prop. Line-----; -------- - ------ ' REPAIR/ADDITION (Prev. Sanitation'Permit#---------:---------------------------- -f- .----.Date----------------- - ---- ----------- Septic Tank(Specify'Requirements).-_,a. -----=------------ i - -------=------- ----- -- - -- I �� .e OS'r Disposal Field (Specify equirements)° �_�-C/ -- ----- -- � -------- - ---`2a`' ..� - ---- - - ---------�------ -- o� �Z -------------------- -----=------ ------ ---------------- ---`----- ---------------------------------- ----- (Draw existing and required addition on reverse side) _ I hereby certify that I have prepared this application_-.1”d 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 i signature certifies the following: ' /� a "I certify that in the perforrriance�°of'the work for which this permit is issued, I shollmot employ any person in-such manner as to' beccomqubbiecte &orkmra 's Compensation laws tof�Ci Ilfornia_." � . 4Owner ' By-, - '!f -----=- �, Title --- -- -- -------- ----- ------------ ---- ------ ---------------------------- �~ . r U other n owner) € ;F R DEPARTMENT USEONLY ' APPLICATION ACCEPTED,BY---------- -- -- -- - - -- -------- ------------- -- ` ----------------- -----------------DATE DIVISDTVI --------------------- ION OF LAND NUMBER..-- ---- - �-------------------------- ------------===�-------- ---------------------- - '---DATE -----�. �----- '.� ADD ITIONAL'COMMENTS'� ,:-. ------------------------- ---------------- ------------------------------------------ �------ -----ia F. - ---- -- ----------------------------------------- .. ------------------------------------ r -------------------------------------------------------- Fi of Inspect------------------ ------- ion`6y: _„ - = =---'------------------------------------------- Dare/ ---t------ o EH 13 24 SAN JOAQUIN LOCAL HEALTH DISTRICT F&s 21677 RM 7176 SM