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FOR OFFICE USEFOR OFFICE USE- APPLICATION APPLICATION FOR SANITATION PERMIT �`� -- Permit No. _--__--------------- ----------- ----------�`------------- (Complete in Triplicate) w. P ' ate Issued-- -------- --------- --------- .This Permit Expires 1 Year Froin Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described- PP e with County Ordinance No. 549 and existing Rules n J--T - , This application is made in cq p�i.c r, y . CENSUS TRACT-__---- -----'----------- L - -- ---- ----------- --- -- -----------ADDRESS/LOCA T .. --------------------------- ON -- ' ----- ----- Phone��/.S' 7 soZ ` Owner's`-Name--- -- --------- -. f h Cit _ 2----"-------- Address-" License #_ .3_ Phone.- ^- ' - ------ S— Contractor's Nome_ %� .r "` - - ' ' "' Apartment House.❑ Commercial Trailer Court ❑ ( Instollation'will serve: Residence ❑ P ;Other.__.-__ : .Motel ❑ ----------- --- -yR ............................_-----------" i Number of living units:. Number of bedrooms= - Garbage-Grinder, === Lot Size I Water Supply: Public System and name----------------------------------------=----- =: Private PP Y I L ( ° Peat ❑ Sandy Loam ❑ Cay Loam ❑ Character of soil to a depth of 3 feet: ; Sand Q ''Silt❑ Cl,ay'❑ ' Hardpan ❑ Adobe Fill Material_.. .. .. 1f yes, type--------------------------------- n reverse (Plot plan,, showing siFzeJof lot location of systerri in relation`to �ivells;6uild;ngewer is avabable within hon 200 feet,)�dQ l ( NEW INSTALLATION: :(No septic tank' or seepage pit permitted, if public c p 1 1 P Size - --- -- - --_-Liquid d 1 4( De th SEPTIC.TANK PACKAGE TREATMENT [ ] PA ------No. Compartments. =--- -- Capacity. -ea- rTYPe {- Nlaterial�J " Foundation:-�'-�=-�-. -_- -------------- - - - '- Pro:p. .L ine---`�- --r-- - ------- - -- 'D neistnce.to arestWellTotal Length _ - ------- - :t- -.-- . .. .�.- -Length of each ------------ LEACHING- -- ---- LEACHING"LINEofLneso r ----- ------- Filter Materia ' ,-- D' Box--:-. ..-7 pe Filter Material%&4 _ Depth ._ . _�?�� ation:�� --------------------Property Line" - Distance to nearest: Well. �- ------ --Found � I SEEPAGE PIT L l Depth. - D.iameter_... '- Number Rock Filled Yes ❑ No ❑ Rock Size - -- Distance to nearest: Well--------------= :- }`Found Water Table Depth----- ---- -- � _ rop. Line----------------------- i ation - P - -. ..-Dafbe- ----------------- ----=------ 7 REPAIR/ADDITION (Prev. Sanitation Permit#-------------- - ---------- ------- ------------------------------------------------, --- ='-` ------- ------ Septic Tank (Specify Requirements)__..._...:'-_"__- - , Disposal Field (Specify Requirements _- ------------------.----- ---------------------- P -------------- ----- - -- ----------------- - . ---------------- - ------------------- # - -- ------------------------------------------- ; --------------------- ( ( - (Draw existing and required addition on reverse side) -San oaquin Counon ad at he work- be done in accordance w;tth 1 hereby certify that,l •have_ prepared this appUcattonsnof}the+San JoaquinlLocal Health DistrictHom ownerr or,lic en agents Ordinances, State Laws, and Rules and Regula I signature certifies the following: r 1 "{ certify that in the performancelof.the work for which this permit is issued,,) shall not employ any person in such manneras to be com su 'ect to r ,orkman' Compensation laws of California." Owner i Signe __ =---------- ------ ------------------- 1 Title - f By :: ---------- (If,other than owner. O DEP- RT--M--- TMENT ONLY , ( / ----- ----------- °w' �5 DATE.---- --- =7 APPLICATION ACCEPTED BY.__.:_.----- -- DATE.-------------------- DNfSION OF LAND NUMB ADDITIONAL COMMENTS' = - --------------------------- ------------------------- - c ----- -------------- ---- - i . -- --- �. -- ------------------ --------- -- . --- D ------- ate Final Inspection-by:------ - F&5 21,177 '!N' EH 13 24 SAN JOAQUIN LOCAL HEALTH DISTRICT �L _�