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R OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No. � (P (Complete in Triplicate) __..---_-- Date Issue ---- --- ------ - This Permit Expires 1 Year From Date Issued rein ------ --:------- work application is hereby made to the.San Joaquin Local Health District for permit to construct an�u�estalnd RRegulations.. described. This application is made in compliance with County Ordinance No. 549 and existing 4 CENSUS'TRACT -------------- ----- a4 ii4_ JOB ADDRESS/LOCATVON -- -- -------------- Phone ------------------------------------ ----------- _--------- - --- V --- ---------- = -------- ------------------------ Y -%--- ------ i2 ` �_ Owner's Name -- M F City G / -f .. � -- --------- -- } 6 � �`- 4h he --------------------- ! Address - Q -- ------- - Licenses o Contractor's Name ._ [0 mid �� Commercial: , Trailer Court `❑ i artment House i installation will serve: Residence l�'AP e ' Motel ❑Other ---- Q4-- ----- , -------- units:.._..-�_.--- Number of bedrooms . ----Garbage Grinder I'AA)d- Lot Size Private F Number of living 7. >' --------- - - ------- ------------- Water ---------- - t Water Supply: Public System and name ------------------------- Peat F1 Sandy Loam .❑ Clay Loam .Q Silt❑ Clay F-1Character of soil to a depth of 3 feet: Sand:❑ -------_" Hardpan ❑ Adobe Fill Material ------ ---- if yes, type - -- r i r laced on reverse side.) \ E of Ian, showing size of lot! location of system in ration to wells, buildings, etc. must be p (plot p : �t permitted if public sewe"r is available within 200 feet,) i � � � NEW INSTALLATION: (No septic tank or seepage p P1\1 „ Liquid Depth -- ---- Size--: }x. X -� 4 PACKAGE TREATMENT [ ] SEPTIC TANK �.�-------•---- r R-�n M&terial:_-i ”" No. Compo vents Capacity 0 ------- TypeQ-. ` Prop. Foundation -_ - Line s -------• i � .-- Distance to nearest: Well ------� �l -------------- N1 ------ Total Length :��-�----- i ----- Length of each line ij � LEACHING LINE f ] No. of Lines --- -- t }� ----------- _ 17 T e Filter Material jr�.:�_..----f�epth Filter Material -.--- - �' � 'D' Box -,/►'.- -- yp J •----- _ _/ �. ---- ------- Property,:Line i ---'- -~ Foundation Distance to nearest: 1l+�ell _--- -- - ,f Rock Filled Yes o Diameter 3-3- ---- Number ------�----------------- SEEPAGE PIT [ Depth - �.{ - I is ------ .Rock Size --�-oda---�-�----------- --------------- �. Water Table Depth ---z.. t<.1 - _ �, �.._ �. _ ------------------Foundation ----�®--�--- Prop. Line �---=5------------- Distance to nearest: Well --------- - � 1rtON(Prey. Sanitation Permit# --- Date ---------- Septic Tank (SpecifyRequirements) -------------- f r `l��r�rz,J_.-.- -��------------------"---------------- 1 . Disposal Field (Specify 'Requirements) a r +� w-- ---- ------.- =-- ---------•------------------------- ----------------------------------- - ' _ ----- --------------------------------- --------------- - --------------------- -------------- - -(Draw existing and-.required addition-on•reverse side), , q hat the work will be ne in ce h Son Joaquin I hereby certify that I have prepared this application and taf the San Joaquin Localot�ealth bistr'dCtnHome towner or B can County Ordinances, State Laws, and Rules and Regulations ! I sed agents signature certifies the following: )o an arson in such manner "I certify that in the performance of the work for which this,permit is issued, I shall not amp y� y p k' as to become subject to Workman's Compensation laws of California." 3 Owner Signed ------------------- ----- ----- ------ ----------------------- Title-- -------------------------------------------------- By -------- --------(I other an owner) k FOR .DEPARTMENT USE ONLY DATE ...4~ ------- ----------- APPLICA710N ACCEPTED BY --- -- -------- -- - - - --- ------ _-- - --- DATE ---------------------------- -------------- BUILDING PERMIT ISSUED ----------------------------------------------------- ---------�----- ---- ---- ----- ----- ---------- ----- ------------ ---- ---------- --------- ADDITIONAL COMMENTS ------------------- , ------------------------:----------- _i------- ---- - -- - ---- - - --------------------------------------------- ---------------------- -- --- ----- - ------------- E F -- - ---- -- -- --- I-- -- -- Date ---- Final Inspection b S N`JOAQUN LOCAL HEALTH DISTRICT- E. H. 9 1-'b8 Rev. 5M