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FOR OFFICE USE: FOR OFFICE USE: APPLICATION FOX SANITATION PERMIT 1?t Permit No. ----------------------- ' M (Complete in Triplicate) Date Issued-,??� -�--This Permit Expires l Year From Date Issued the work Application is hereby made to the San Joaquin Local Health Dis�lot549 and exist ng Rulconstruct es and Regulations herein described. POrdinance - M1 This application is made in compliance with County � y , .�, - EN TRA - ----------- C -- -. SUS TRACT - -- -- JOB ADDRESS/LOCAT N.__.. Ph i _ ` -- - -- - - Owner's Name--- ----- - ----- ---- T City -- -- Address-- - Phone--I/O.- # . -------.----License � p ' 1 Contractor's Name-------------------- ❑ =.Com r---------------❑ 'Trailer Court,❑ Installation will:serve: Residence Apartment House Commer€1al 3 .t_ Number of bedrooms _Ot ara e Grin Motel-❑ R -- • - - � � erg=-` -- ,':Lot`Size- ----- ----------- b Number of living units:_---- -----Num ------ - -- a e f _ -- Priv _____._ __ F Supply: Public System and name--- ------------------ Water ,;� Character of soil to a depth of 3 feet: { Sand ❑ :Silt El Clay ❑ Peat❑ Sandy Loam ❑' Clay Loam ;Hardpan ❑ Adobe. Fill Ma01 terial...._:--_.-.If.yes,type-------- ced n reverse (plot plan, showing size of lot, location of,system in relation to wells, buildings,etf.1$mavtab leawithin 200 feet,)1de.] } it permitted if public sewe NEW INSTALLATION: .(No'septic tank .or seepage Size=------ ------ -� Liquid Depth.------------- ------- F-SEPTIC TANK' N ---- - ------ PACKAGE TREATMENT [ �"'; `= _Material--- ' - --------:---No. Compartments-------------- 1 Distance to nearest: Well_e-_ - Capacity------ ----- ::Type xi.::�w:r -' == ---- ------.Prop. Line---------------- a i Foundation. y No}.'off Lines---. Length ofveach'lin&-------------------_------ ria_..Total.Length :---------- ---w LEACHING LINE, .[ } 1 ( _ -- -------------- D' Box------ Type Filter Material-,---------------------Depth Filter Material l'-- Line v Foundation ------ ----- Property .; --- --- Distan�&to nearest: WeIL,"--------------- •. ; Rock Filled Yes ❑ No ❑ SEEPAGE PIT [ } Depth -.---- --- --Diameter_ - -•'----Number- -- -- --- -- - --- ,. Rock Size ". Water Table Depth __.__ -- -- --- t ------- ---------- Foundation--------- ------..Prop. Line---------- = 1 Di•starice'to nearest: Well-..-_- --- - , ------�-•-=-`�_-'-:Date:��=- - ----- 1 REPAIR/ADDITION (Prev:Sariitation-Permit#.----:--- k-------•----' _� , :' =- - r--- - Septic Tank (Specify Requirements]_---:-- "---- ..y �Q ----- Disposal Field (Specify Requirements]_ -. -- -- - ---- ---- r - - -. --_--. - -----. ------ ----- ------- -- - ----- - ----------- - - R - i '• T-• -.4'"� .- (Draw existing and required addition on reverse side) , ance 1 hereby certify that 1 have prepared this application andittaethe San joaquinlLocal Health Distrbe done, in ictd Horne ootwnerr orh Son Jlicensed agents Ordinances,' State Laws; acid Rules and Regulations o signature certifies the following: - "I cerci that in the performance` f the work for which this permit is issued, I shall not employ any person in such manner as certify t i to become ct 1to Work n's1, Comp nsati laws of Cal'fornia." } r . er„ Signed----- : _ - � . # Title -------------------- ----------- ------------ , BY-7--- -------- =� = = (ti < (If other than owner) t . .. 'FOR DEPARTMENT USE-ONLY ---------------- ^� , ,kil s - - =---DATE.---- APPLICATION ACCEPTED BY _ - DATE--------------- -------------- •-------- - ----- DIVISION OF LAND NUMBER i------ ------------------- --------' --------------------------------- - - - - ADDITIONAL COMMENTS_.._- --------------- -------- ---------- ---- ,4 - ------------- =----------------- ------ ----------- ---------- ` i------------------ --------------------_----------- - ---------------------------- .' ----------------- _ to : 4 ---Da Z{J ------------------------------------------------ F&S Inspection by:---- � - �" sibs Rev.7l76 3M SAN JOAQUIN LOCAL HEALTH DISTRICT ti EH 13 24 l - _