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; = FG� OFFICE USE::- Appy aCATION FOR SANITATION PERMIT Permit No. --------------------- -- �-/a --- ---- ---- ,Complete in Triplicate? c� Date issued ---� --- - This Perm'st Expires 1 Year Fram Date Issued - ------------------ it to construct and all e work herein Application is hereby made to the'Son Joaquin Local with Health District for -ordinance Nom549 and existing Rules tand hRegulat ons-. PP application is made in compliant described. This app ' , ---CENSUS TRACT 11 s f,/1/ 14 JOB ADDRESS/LOCATION - / ---Phone ----- '/=--------------------•----- Owner's Name -------- = - ------ Address5'--- 7� Ul _.- -M1_DD L ---------------- city --- - ,�-; -------------- i Phone - ----- ------------------••-- J f r � Lcense # Contractor's Name ' ----------------------- - Residence partment House❑ Commercial :❑Trailer Court '.❑ � f installation will serve: , ; Motel ❑Other ------------------------------------- r�0 Q0 - �-____Garbage Grinder _--��- tot Size ,�._-----d---------------- Number -- ----- ---- •- Number of living units:__--I_ Number of bedrooms _ a ------------ Water tF Wafter Supply: Public System and.home`:----------- Peat Sandy Loam,Q Clay Loam P feet: Sand'[] Si Clay ❑ /, Q ------ Character of soil to a depth of 3 Hardpan ❑ v,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.} A P 4 permitted if public sewer is available within 200 feet,} 1 1 — see a Pit'. XI L;quid Depth -----1 .-- PACKAGE TREATMENT { ] P NEW INSTALLATION: (Nose tic tank or Size--_-- ----- PAC SEPTIC TANK `o�. /IGT—�No. Compartments Capacity, �--��Mater{a1--� ------ ---- t Type 4 We. JQ� `=-f✓i ., Foundation ------- Prop. Line ;stance to nearest: Well __ _--- Y. , LEACHING LINE { o. of Lines -- __ -__-_____--y Length of each line_-.--- �- Tota! Length/ f--.�-•---- •- -.y. 1----------- 'D' Box - -- S/Type Filter Materiel - ©C lDepth Filter Materia -_-- - - r Jjo -�---__-- Property Line - '� Foundation Distance to nearest: Well Jv ------ ,--- fl,� Nurr,ber ----- ---------------- Rock Filled Yes ❑ No �❑ Diameter -- �- - SEEPAGE PIT [ } Depth - --------------- t Water Table Depth ---------------------------------------------i Rack Size - t Pro Line --------------------------- Foundation ----------------- -- p• Distance.to�nearest: We __------ _ - i ` i Date -------------------------- ----------- ) REPAIR/ADDITION(Prev. Sanitation Permi --------------------- ,.�.�.. - Septic Tank (Specify Requirements) ---- i. v1;�t- ---s i'wi"--^5 ----- - ------- ------- Disposal Field (Specify Requirements) ---------•------------------------------------------------ -------------•--------------- ----- ------------------- - ------ -------- - --------------------------------- ----- ---------------------------------/------------------------------- --------------- ----------------- ---------------------- ----------- ----------- ----------------------- - - � (Waw existing and required addition on reverse side) -- ^' lication and that the work will be _*_n_e accordance with San Joaquin I hereby certify thatl have prepared this app County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Home owns* or licen- sed agents signature certifies the following: p y: person in such manner "I certify th t iri`f a performance of the work t on lgws of' CaliFornia•+issued, I shall not em to any as to beco subj t to r m n' e ------ Owner - 1It r- , •• --- -- -- - -------- - - =------------------- Signed € (if other than owner) FOR DEPARTMENT USE ONLY DATE --- APPLICATION -APPLICATION ACCEPTED BY'--- t �- - - DATE -------------•---- BUILDING PERMIT ISSUED ---- ' --------------------------- = ADDITIONAL COMMENTS - I ------ -------- ---- -------------------------------- ------------------------------ ---- -------- ----------------- -------- - ---- -- - •---- -= f=inal,Inspecfii.o._._� SAN JOAQUIN LOCAL HEALTH DISTRICT E- H. 9- 1-'b8 Rev. 5M