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FOR OFFICE USE: FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT �7 / Permit No.- .. -- ---------------- ... . . --- - ------ (Complete in Triplicate) _ ---------------------- ------------ --- � ._— Date issued..�-"� --' -••---. -------------'--' -------------- This Permit Expires 1 Year From Date issued made to the San Joaquin Local Health District for a permit to construct and install the work herein described. Application is hereby ` This application is made in compliance with County Ordinance No549 and existing Rules and Regu lotions. 1 m �-.� TRACT--- - --------- -------�- - -.- -•--------------------- ----------- JOB ADDRESS/LOC TI N - - _ - on -------- ----- - ------- ---- ---- - - � ., ner's N'ame' r ' - Zip Ow .Ci - --- Address-- License # ne �----- - '--- -'-- - -- ' ----------------------- Contract '- ---' - --- ' - Contractors Name---- - ------- Apartment House.❑ Commercial ❑ Trailer Court El" Residence AP Installation will serve: -`777'--Motel 0 Other ---- ---- -- ------------ --- - .._ I -� __ � Lot Size..},� ----- -'- x --._Garbage Grinder--------- -- Numbe'r of living units:._:--- -_--Number of bedrooms s_. -.----pnvat --------------------- Water Supply: public System and name..--`-.-.-.---=------ . ' . - Peat ❑ 5andy Loam yi Clay Loa ❑ Clay ❑ Character of soil to a depth of 3 feet: Sand ❑ Silt❑ Cla y Hardpan ❑' Adobe ❑ Fill Material------------ es, type plan, showing size of lot location of system in relation to wells, buildings, etc.must be placed on reverse.side.) {Plot P ;.. T Nose tic tank or seepage pit permitted if public sewer is available within 200 feet,} r NEW INSTALLATION: ( p ------Liquid Depth---------------- ----- -� SEPTIC TANK L ] Size------------ --------- ----'------------- It PACKAGE TREATMENT ['] artments----------------------------------- rr `. - �T. e ' -----Mate'rial -------- ------------ No+ Comp Capacity :-�.== "� ,. yp = ----� _`Foundation:^. - :Prop. Line. " Distance to nearest: Well.:. = t - ------------- - ' Length of each line.-.]----_ , --------------Total.Length.__ { Na. of Lines. --- g _ . LEACHING LINE L } - ------ _ D' Box_.---------TYPe Filfier Material-------------------'Depth Filter Material---'-------- „ Foundation------------------------------Property Line------------:- ` " Distance to nearest: WeIL"�_---=------; F Rock Filled Yes ❑ No r. SEEPAG -. Diameter--------- --- ---Number.__: E PIT L } Depth t ------ � -------------------------- ---- -----'----- ----.Rock Size--- -- ----------------------------------------- Water ;---= ------ ---- ----- - Water Table Depth--------- - ---- - Foundation---- ----------- --------- Line. 4 = ------ , Distance to nearest: Well."':_'"" - -:- - t 1 -. . "' Date------ ------ ----------------------- ? REPAIR/ADDITION (Prev y Sanitation Per> .# " -ter ------• - ----- - -------- ---- *i --- 5eptic Tank (Specify Requirement )f_.-=== --- - r ------ Septic --- rsf ------------ =� Disposal Eield (Specify Re uirements} -_ " -_------------------- -- --------- -- --------------------------=---------------------------------- ---- r ----- - (D�aw existing and required addition on reverse si e I hereby certify that 1 have prepared this application and that the work wiaccordance with San Joaquin County ll be -done Ordinances, State Laws, and Rules and`Regulations of the San Joaquin Local Health District. Home owner or licensed agents t- signature certifies the following: - - to any person in such manner as "I certify that in the performance of the work for which this permit is issued,'1�shall�not emp y to becom bj t to kma 's. Compensation. laws of California." Owner � - '-- ------------------ -- '--- ---- ---' n - ---- --Sigo -- -' rte BY' (lf other than owner] FOR DEPARTMENT ARTMENT USE ONLY ------- DATE--- .--- —fes APPLICATION ACCEPTED BY_.. _.._. _;:- '-------------- DATE D1V1510N OF LAND NUMBER -- ------------------ -----�f -- ---------- ------- -- -- ----- --- ----------------------------------- ------=--- ----------------------------------,r-- ----------------- . --------------- --- ----- -' ---------- ADDITIONALCOMMENTS--------:-_- '---- - --------------------------- ----- ----- ---'- ---- - --------- ------ ----------- ----------------- -------------- -------- ' - ---- ------------------------------------ -----------.---':----- ----- ---------'- ----- ---- - --- G ------------------ ate_. - ---- --- "-- --- ------ --- .--- ' 6 Final Inspection b F&5 21677 7 EH 13 24 SAN JOAQUIN.LOCAL H LTH DISTRICT � � ;