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FOR OFFICE USE: FOR OFFICE USE: I APPLICATION FOR SANITATION PERMIT �.�,�� ----- -------------- Permit No.�_�.�._: (Complete in Triplicate) --------- ---------------- --------------------------------------- ------------------------------------------.--------- _.-_ -This Permit Expires 1 Year From Date Issued Date Issued-2 0--d� Application is hereby made to the San Joaquin Local Health District fora perryft to construct and install the work herein described. This application is,made.in compliance with C unty Ordinance No. 54,9 sting Rules nd Regations:011 3 4 So `�w�STW- ° JOB ADDRESS/LOCAT ON ---- - -- - -- ------ --- TACT Owner's Name- S R Of__�3.376� .--- U t " - ne' - , Address-.11::-rJ-.------- ------ --- --- ---- City =_ _ _ w ,._" Gantractor s Name. f/ ---------------------License - -- ----- Phone__/16_S L1r/ Installation will serve: Residence ❑3. Apartment.House ❑ Commercial Trailer Court d f Motel F Oth'er__-=- _ __ - } I Number of livingunits:_' nits:.:.......:.....Num � , Number-6f bedrooms- ----- - -..'-Lot. Size-----0�41.r�Garbo a Grinder.------------------------------------- ------------- --- ""--"Lot,' Water Supply: Public System and name---------------- :-------_----------_-_-_._- - - --_-__-------:---"_--- Private xj --- Character of soil:to a depth of 3 feet: = Sand 0 Silt❑ Clay ❑ Peat ❑ $and_y Loam ❑ Clay Loam ❑ t Hardpan ❑ Adobe Fill-Ma"erial__."-_---_._If es, t j Y YPe = -------------------------- (Plot = 1 (Plot plan, showing size of tot, location of system in relation to-wells, buildings, etc.-must be:placed on reverse side.) NEW INSTALLATION:' "(No#sep1.tic"tank 'or seepage ;pit perrrtifted �f public sewer is available within 200 feet,) PACKAGE TREATMENT [ ] , SEPTIC TANK Siz ": o r. 7 ----- �l _ ------ Liquid Depth. Capacityp _ ��------_Typ - 4 :"''_'Material-- - - No: Compartments---------'. _- e 4 5 `� i " \ .� _ i Foundation_ ._� Pro Line_,.-F _ Distance to nearest: Well-_.�' ��.._:_ Total' e .-:-, LEACHING LINE Na. of Lines.:_ . f g g U Len th of ach.lins. Q_.____,.__„--_- �a Length__ th._. D' Box_. c�7 C _---_Type Filter Material_._____ Q--/ "Depth Filter Material__:_-� _!'.__________ ________.._-- F { I f. Property Line_.S . ---- (~ st: Well-.--/, ___ -- Foundation___ �__. __--_.--. , SEEPAGE PIT De th S Diameter! ra r . ------------- Distance:to neare ' [� ps -;�---- ..--Number-----s�4---------------------- -- _ .�� Rock Filled Yes-:1' No ❑, , s Water Table Depth = � ------- -------- Rack Size Distance to nearest: Well_'_..._... _, ,� _r` -__-___.Foundation./�4-_�_----.__ Prop. Line__, REPAIR/ADDITION (Prev. Sanitation Permit#---:___ _____ __ ______ _ --------------Date--._"- .__--. _ - Septic Tank (Specify Requirements)--- ' ------ ------- = = . ' Disposal Field (Specify Requirements)'------ -- =------- ----------------------- ----- ------=---------------------------------- ----- -------------------------- ' 4 - # = -------------- -- --------------------------------------------------------- ------------------ -- E (Draw existing and required addition on reverse side) I hereby certify that'l 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 DIS�ict-Home owner or licensed agent ; signature certifies the following: I certify that in the'0erfbrmanc6*f:the 'work for which this permit is issued, -I shall not employ any person in such manner'as to becom s lett to , man Compensation Jaws of. California.". d �. Signed------- -- igned .: �- -------------------------- ---------- ----------- --- -.- Owner 1 BY - --- - . .Title -------------- -------- --- � ' - '(If other th'ane ow er) t' EP R DEPARTMENT'IJSE NLY ' A. APPLICATION ACCEPTED-BY - $ 4° -- ---- DATE . -gyp DIVISION OF LAND NUMBER.--- ---------=- ------------------- -------------------------------- TEN'------:------ ---------------------------- DA --. ADDITIONAL COMMENTS--.__________. _ --------- --------------------------------------- - - _ --------------------------- -- ----- ` --- 3 # -----�--------- -- --- ------------------------------- - _ I �4 ---- ___ -- .__- -•-_-"----.-_-_ -"_____________ - .. N- - --------------------- ----------------- - - .V' Final-Ins ection b � P Y Date ------------- EH 13 24 SAN JOA IN LOCAL EALTH DISTRICT gas 21677 REQ. % srn ;