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FOR OFFICE USE: FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ------------------------------------ - -- - 1 Permit (Complete inTriplicate) j ---------------------------------------------------- Date lssued./,J-=3/=7.$� ______________ -__----_______--_-----._._.------ This Permit Expires 1 Year From Date Issued I Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: w 306 ADDRESS/LOCATIO - CENSUS TRA 1 Owner's Name �C --------- -- --- hone----------.-- ------- --�v Address .-� y City Zip I - License -------------------------- -------- -- Contractor's Name-.�� ' - ---- -� --• --- • ------- ------- _ Installation will serve: Residence.Apartment House❑ � Commercial ❑ Trailer Court ❑ Number of livin units:. _-•� Motel ❑ Other-:-:-----------.:------------------------------ - g -Number of bedrooms -J. .___-Garbage Grinder------------Lot.Size.-._ f -- -----------------,-----__- Water Supply: Public System and-name_------------ ---- - - Private ®� _ - _- Character of soil to a depth of 3 feet: Sand ❑ 'S' Clay l] Peat El Sandy Loam E] Clay Loam ❑� Hardpan ❑ Adobe Fill-Material.'.-,--.---If yes, type-------------------.------------- (Plot plan, showing size of lot, location of system in relation to wells, build-ings, etc. must be placed on reverse side.) (� NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) {� , PACKAGE TREATMENT [ ] . SEPTIC TANK �!� *- Size-._ ! - _- ___jn--/�._�/__rg---.Liquid Depth._----- --------------�r Capacity .__-Type--_ - -__ Material---- 4' _.. -_No. Compartments----_---- r_------ �j f a f _471_10_11 / J Distance to nearest: WeIL,.-- -------:-- Foundation--- -_ U_ ------Pro Line- __��- LEACHING LINE. [ No..of Lines-'� __�.-. -----------Length ofe��line -th Fllter Material Total Length ---� ---------------- - -� 'D' Bo � : - ------- ----- ------------- x`-C+�----Type Filter Material------------------ ----- �---/----- - �^ / 7 Distancato nearest: WeII�7a=----r_1".r-.-Foundation _.__-----------Property Line--:-_-_- ------ -. / l lr -Number------ Rock Filled Yes o SEEPAGE PIT �[a}� Depth-�-------:--Diameter-- -- -_-�`" � -=-- -------•--- � ❑ � Water Table'De th .. � �r /rl-� t . - p f------------ '� { Rock Size ° ' _u Prop. Line-------------------- REPAIR/ADDITION ---- - -- ----------- - i Distance to nearest: Well-- .- ____ :--t_ _ --- _.------Foundation-----------_-- _._ REPAIR/ADDITION [Prev. Sariitation Permit# _._---r--: :_- -:-: --�- —_.Date-_--^:--- --- -------------------------M s _ �, , Septic Tank (Specify Requirements)------3-------- ------_ J � � Disposal Field (Specify Requirements]-- -----:--'---------- ------- --- ------_ __--------------- ---'------------ ------ ---- -------------------------------------------- ' a i r -f� i ------------------------------ ----- ----------- ` �f�w f _ {Draw ex-- --- and required ---- ---------- ---------------------- ------------------- ------ ------ -------------- addi hereb certify that I have prepared this application and that the wortiorl,will reverse side) , ` k will be done in accordance with San Joaquin County 5 Y Ordinances, State Laws, and Rules and Regulations of the. San Joaquin Local Health District. Home owner or licensed agents ... :._. signature certifies the following: ' { "I certify that in the performance of-the work for which this permit is issued, I s ah iii-not employ any person.in .such manner as to become-.-s-ub[e Workma Compensation laws -of California." - . t By- Signed- rc rite (I other than owner[ t�. ` FOR DEPARTMENT USE ONLY r APPLICATION ACCEPTED BY------ Ct- - - DATE/d_ 9 _---------- ------ E DIVISION OF LAND NUMBER -- ------- --=------------- -DATE-------------------------------------- -------- ADDITIONAL COMMENTS--- ------------- ---------------------- -- - --------------- -------------------------- ------------ ----------- - --- - k- --"---"---- ---------------- ----------------------------------------------------- ----------------------------------------------------------------- _ -------------.-.__ - - -______--.----------------------------------------------- ----_ ------- --_ Final Inspection b �.^ ------------------------!-.:--Date---- 1 0.07 F&s � REV. �z EH 13 24 SAN JOAQ IN LOCAL _HEALTH DISTRICT 21h zearn r