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FOR OFFICE USE: 'FOR OFFICE USE: r/ �s APPLICATION FOR SANITATION PERMIT •7� 73� ------------------------------------------------- Prmit No,---- --- ------------ {Complete in Tr' lic e} ------------------------------- ------------------ 1/) e sued._�-3d`-7_- This Permit Expires 1 Ye r From s . Voe Application is hereby made to the San Joaquin Local Health Distric or ermitto construct and in all thein described. This application is made in compliance with County Ordinance No. 549 and existing Rule and Rb latior�:JOB ADDRESS/LOCATIOj�I. E SU5 TRA 6' ----------------- --------------------- Owner's Name ------"--�.- �� . :. ------ --------Zi ------------ # - �- r -C!`F 13 city---- c ity--- _ P------------------------------- Address Contractors Name__- _ '- _ ' 3.--------- -- '�'>°' � ---- -- -L'cense #,,. _, _Phone _ - = -7.6- .-- � � Installa4�ion will serve: �� eslden6 (� par mens ouse.❑ Commercial ❑ Trailer Court ❑ 1 Motel 0 Other-------------------=---- Number of living units:------- _----Number of.bedrooms---3-----Garbage Grinder--------.---Lot Size_ .__ �_'��-��----------------------- 1 ----------Privat Water Supply: Public System and name-------- ---"----- --------------------- ---- ------.------ :_ ------------------ e Character of soil to a depth of 3 feet: Sand ❑ -Silt ❑ Clay ❑ Peat ❑ Sandy Loam ❑ Clay Loam ti Hardpan ❑ Adobe ❑ Fill Material__---------If yes, type___ __________________----..__ ° (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) r PACKAGE TREATMENT ( ] SEPTIC TANK I Size-------------------------- _ ----- -----------Liquid Depth--------------------------- S�� f opacity- -------------------TYPe---------------- -----.Material----------------------__._No. Compartments Distance to nearest: Well----------------- ------ - Foundation--------- -------Prop. Line------------- ------------- LEACHING LINE [ ] No. of Lines,,;___;____.___._--, ---.Length of each nr line__..__ ._ _ ------------Total Length --------------------------------------- �. 'D' Box Filter Materi -- al_/ -L�_�?�{4epth Filter+Material---- a--__ _ _ -_._ --------------------- ----------------- E�� s�r _ Distance to nearest: Well__ _ _ _ --------Foundation__ r__f___..____---Property Line----- f ------ SEEPAGE PIT [ ] Depth__/�'___-Diameter-/&;25 Number �______-___.___ Rock Filled Yes ❑ No❑ - Water Table Depth-----------------•---------------------------------------Rock Size-------------- ------------------------------ -- Distance to nearest: Well._.--5_.,_,4�--- _-__._ Foundation--7-+�-------- --.Prop. Line------ ___� ----- ---- ' - Date----------------"----------.-------------- ----1 REPAIR/ADDITION (Prev. Sanitation Permit#_________..__..---------------- -�, -w Septic Tank (Specify Requirements)____.__ --- --s. ' Disposal Field (Specify Requirements) ---------------------t- - -----------------`------------- -------------------------- ---- ---------------------------------------------- -------------------------------------------- ----- : " . - - 1 (Draw existing and required addition on reverse side) I hereby certify that I have prepared this application and 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 fallowing: "I certify that in the performance of the work for which this permit is,issued, I shall not employ a y person in such manner as to become subject to Workman's Compensation laws of California." ` Signed------------------ ----------- ----------- --------- ------ Owner BY-11----- P 'Title_.�L�Ef (lf otkier than owner] FOR DEPART T E ONLY APPLICATION ACCEPTED BY ------ - -- ------ }------ - - ------ ---- ------DATE --------- ---------- DIVISION OF LAND NUMBER ------ ------ - .DATE---- --------------------:------- ------- --- --- ADDITIONAL COMMENTS------- -------------- - --------------------- ------=----- --------------- - -- ----------------------=-------------------- ----------------- - --- - - - - ---------------.-------------- ---- ------ -- --------- ----- -.- -------------- - ------ - --- - ----- ----- ----------------=-------------- 's. ______________________________________"-----_.___.y___--______.--__[IAN ______-----____._.______"_ .__________ __"__________ __________ . Final Inspection b ------------------------------------------------------------=---- ---Date---------- -- --- --------------" - --------- -- EH 13 24 JOAQUIN LOCAL HEALTH DISTRICT y F&5 21677 R6 3M