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FOR OFFICE USE: FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ------------" --- ----------------- �,�� {Complete in Triplicate} Permit No.___7_________ -------------------------------------- -- - d Date Issued.-f-7-22- ---------------------------------------------- ssued--�:9-_��_ �w .------_-------------------------------------_------ -- 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 des ipzk This application is made in compliance with County Ordinance No. 549 and existing Rules and Re ulations: JOB ADDRESS/ OCATION- �'T�.G - ----- _,w_)�--`-- ------ - ---- ----� -- ----'- ---.CE SUS SACT Si'f fi'�C4C Owner's Na .�- -� --- ---- ---------- ----------------- ---------- Phone----------------- -- --- ICS' -City Zip Address `'®t = --------- --- Contractor's Narne.__ L_ --�F- -. ?+� ___ ---___--.:License #. C��3_ "_Phone__-- _ Installation will serve: Residenc Apartment House.❑ Commercial ❑ ,Trailer Court ❑ Motel ❑ Other__ Number of living units -.__:-=s_:----_-Nu.mber of bedrooms------------Garbage Grinder------------_Lot'-Size-_-___-_1-------- =� �._____'___.__'_ I PP Y Y P Water Su ! Public System and name -- -------- :.- ----- --------------- rivate . . i p f 3 feet: . Sand ❑ Silt❑ Clay ❑ Peat❑ Sandy Loam Clay Loam ❑ Har F Character of soil to a depth of ❑ Adobe-❑ Fill Material..--!......If yes,type-----_-.--_-----.---"----_---- j (Plot plan, showing size of lot, location of system in relation to'wells, buildings„etc. must be placed on reverse side.) { i NEW INSTALLATION:- "(No'`sepfic"tank-or seepage-spit permitted if'public sewer is available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIICTANK , � --------------------------------Liquid Depth Ca --------TYPeCompartments = - a cit -pom � c � � -- _ _ _ - �:Distance.,to.nearest: Well- . -- - ---------------------Foundation-- --_ Prop. Line_..- . ._.-f__� f LEACHING UNE No. 'of L'ines_;__ ___-----------------Length of each.line.____----------- -:--Total Length._,__._ ._.@____,_____,_.__._____._- `D' Box.--- --- -Type Filter Material- ---Depth Filter Material------18-f-_-.____,____________________I_ ___________ _ f F f ' Distance to nearest: Well__"--------------- oundation.--.---_l©__ ___-____-Property Line--.-1 ___-_---_ _.__.----- SEEPAGE PIT [ ] Depth-----------------Diameter_--------------t----Number---:-------------- ----__ Rock Filled Yes❑ No Water Table Depth--- ------------------- +-------------,------ -- Rock Size- ----------------- --------------- Distance to nearest: Well- ------------'------'----------------__-- Foundation------------------------- Prop. Line-------=----- REPAIR/ADDITION (Prev. Sanitation•Permit#-- :__-- ----- -----'"----_ ----- Date------------- } Septic Tank (Specify Requirements)---- - - ---=------------- --------------------- -- Disposal Field (Specify Requirements)----------------------- ---------------------------=----------------------------------------=---------------- ----- - ----------------------------------------------=------------------ ------------------------------------- ------------------------------ ------- --------------------- --- ------------ -- ---- ----------- -------------=------------- ----_ --- ----------- -------------------- -------------"------ - --------------------- ---------- ------ ------------------- ” {Draw existing and required addition on reverse side) hereby certify that.] -have prepared•this.application and that.the work- will be done in accordance with San Joaquin•Cou ty Ordinances, State Laws, and Rules-and Regulations of.the: San Joaquin Local Health District, Home owner or licensed age signature certifies the following: "I certify that in the perf ance of'the:work for which this 'permit is issued, I shall not employ any person in such manner to become subject to . r : .an's .Compensat on laws o California." ��— e. , � Signed -- --- - --- -- ---- - ---- --- •x 7 , BY ------------------"-.--- - -- Title----- (If'other than owner) " FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED. BY =' = DATE. _ 7 7 - DIVISION OF LAND NUMBER ------ ------------------ -- - .----.DATE ------------------ ,----------------- -- ADDITIONALCOMMENTS--- --- --- ---- --------------------------=-------------------- ----------------------------------------=--------------------------- ------------------------------ ----------------------------------- ----- - - ---------------------------"------ ------ ------- ------------------------------------ - -------- ---------------------------------- --------------------------------------------------------------- . . ,. F1nal Inspection bY._ ="---------------------------------Date -- ------7 - ---- ----- EH 13 24 SAN JOA IN LOCAL HEALTH DISTRICT F&S 21677 REV. 7/76 3M