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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No. --- � a . -------- (Complete in Triplicate) :/ /.f Date issued ---- ---- -------------------------- •. z .This permit Expires l Year,From Date l'ssued 1 -- ---- - ------ - --- , ' permit to construct and install the work ere+n Application is hereby made to the San Joaquin Local Health District fora p 'on is made +n compliance with County Ordinance No. 549 and existing Rules and Regulations: described. This applicat+ -----CENSUS TRACT "---- ------ . - ------ one -----------------•--- JOB ADDRESS/LOCATION .----- - a r ------- ------ -- ----- - ---------------------------•---- Owner's Name i ---- ----- .7ro - - C"f �� phone Address - - - -- --- -1 f�, /� License # . . -- - - . artment House❑ Commercial :❑Trailer Court i❑ Contractor's Name ------ --- - -- - Residence)ZAp installation will serve: Other ---------------------------------------------- .6-P ---------- - """ ' Motel ❑ ';..*r. ,%� Lis `c rG� r Lot Size - - --- -------- ------ - Number of living units:"-- ---- Number of bedrooms ---- --- Garbage;Grinder k private ---------- ---- ------------ Clay Loam Water Supply: Public System and name --------- ----------------- pea"t.O�-Sandy Loam ,[] Character of soil to a depth of 3 feet: Sand'❑......-Silt❑— Clay ❑ , # Hardpan ❑ Adobe $( Fill Material �'---- if yes,type --------- l (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) it it ermitted if public sewer is available within 200 feet,) �;i t Depth NEW INSTALLATION: (No septi tank or seepage p p ---_-__ Liquid Dep SEPTIC TANK,j l Size--------------- ------------------- $ I •------ PACKAGE TREATMENT [ ] '1 _ -"_ Material------------ ---- --- No. Compartmen s Type ------------ ----- Prop. Line ----=-------------- � Capac+tY--------------------- - ------------------Four+dafiion ---- ---- --- --- - i Distance to nearest: We ------------------------------------ Total Lengthr.------•--------------------- No- of Lines ----------- --------- Length of each line -1--o- ---- ---•-- LEACHING LINE [ } Depth Filter Material ------------- T e Filter Material ------------ -- - 'D' Box ------------ Type. + Property Line ------------------------ Foundation ---------------- - --- Foundation ---------------------- t Distance to nearest: Well ---------------- - Rock Filled Yes ❑ No I❑ _ Number ------------------- ---- ---- SEEP G_ ; Depth - Diameter ---------- --- ,I-1 e --- ----- -- - -- ----------Rock Size --------------------------------- s Water Table Depth ---------------- - Foundation Prop. Line Distance to nearest: Well ---------------------------- , _ ___•) REPAIR/ADDITION(Prev. Sanitation Permit l * --------- ,.. - -------- Septic Tank (Specify Requirements) - .�--��a ' Disposal Field (Specify Requirements) --- ----------------------- - --------------- ' - f --- I' "" -- 1pr exis ng and required addition on everse side) �e ared this application and that the work wuin Locall he one in Health``Distrtlt.Hornece towner or I cen- hereby certify that I have p p L,. County Ordinances, State Laws, and Rules and Regulations of the San Joaquin -person in such manner sed agents signature certifies the following: permit is issued, I shall not employ any "I certify that in the performance of the work for which This as to bec e s bject to Work an's Compe tion laws of California." AT Owner ! --------- -- ------ Signed -- - ---- - � Title --- -------- --------------------- --- - By ___ _ ________(If other an owner) FOR DEPARTMENT USE ONLY --•--------------- ----------------------------------------- -- ---- ---- ----- ---- --- --------- ' DATE - -- --- ----- - ------- DATE -------------------------------------------- -- ---- ----------------- ---- ---- -- APPLICATION ACCEPTED BY ------------------ BUILDING PERMIT ISSUED -.-------- ADD17lONAL COMMENTS ------- --------- -------------------- - - -------- Date ."-- /"---- _ ---- --- ----- --- ------- ----- Final Inspection by: -- �-� - ------- """"-- SAN JOAQUIN LOCAL HEALTH DISTRICT „ ,_'AA RPV- 5M