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---•-•--._- -.,—,..rte� 4 ,:s .. ,X FOR OFFICE USE: " FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT _ Permit No.-- "-- '� -------------------- (Complete in Triplicatel q j Date -------------------------------------------------------- This Permit Expires 1 Year From Date Issued ------------------------------------ ----------- t Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein describ#d. This application is made in compliance`wifih County Ordinance No. 549 and existing Rules and Regulations: _. - - -- ------- -- CENSUS TRACT - �_ JOB,ADDRESS/LOCATION d., _., � - P on e------i �--- -�-----�-- --- ---- ------------ ---------- -------------Owner's Name ..._ . I ---- ty- �7//� � --------- -------------- Address_ =----------- Phon -------- ---- nseI Lice L ^ 44 Contractor's Name Traile�r�Co El installation will serve: Residence ❑; Apartment House Cpoepl [] �4A L x Motel 0 Otheri4_/' sem . av` -------------- bedroomsNmber.of living units:---,-/ ------ of .___._.____Garbe rider_.___.,._ _Let Size__._. ----- - :; Private,9 t - - -- -- -- Water Supply:_Public System and name_. -- - r ,Silt �'C a Peat❑ Sandy Loam�' ,Clay Loam ❑ Character of soil to a depth of 3 feet: Sand ❑ Y, r ` :Hardpan❑ Adobe©lF;II Material :.__ -if yes, type_ -._ -- -------------= ; 5 O ' (Plot plan, showing size of lot, location of system in relation to wells, buildingewer is avaldble+within 200feet]d ' Q NEW INSTALLATION." is tank or seepage ,pit permitted if public �. SEPTIC TANK ( l "Size -? P`�-�.- -- Liqu;d Depth }�lP1� �t PACKAGE TREATMENT . [ ] , SEPTIC 4 - ?'Material_- ---------------------No. Compartments_. --- -`:----- 4 Capaci•ty�t ----- -- Typ i I. -------- fT .-.: ---- Foundation-_' �-- Prop. Line_ __iQ Distance to nearest: Well - --=------`' : -- --- : + -, � ,T } Len th of each line._,-- =- ---Total Length.._ ._ LEACHING LINE. (-] No. 'of Lines =._ - 9 �. i 4% e th Filter Material-_ 17-.�� F D' Box I. --Type Filter Material .,p� ,. • -�—. :. ,.. -----------Q # �.< - . f ... ` . t�-ri �;.-,_Foundation- ./d, AProperty Line. . 3_ Distance to nearest: We11_p� - - --- :... _ .�'.3 Rock Filled fYes ❑ No ❑ ] _ Number = SEEPAGE PIT I 1 P De th s„� ► Table De thmet1.er 1 . ---- Rock Size = - .. Water P - a:. � rest: 1Ne11 ---`.. . :..._ - Foundation-------------------- -----Prop. Line--=--------- - ----- riea r Date REPAIR/ADDITION (Prev t Sanitation Permit# -- -- r- --- - l1F = ----- --------------_ _ --_=--' :-- j Septic TanklSpecify Requirements]' = : ------ ------------------- '. Disposal Field (Specify.Requirements)-- ------------------- - : - , --- ------- E-------------------------------=------- _ -- - ------------ -------- - ----- -==-----------------------I _.. ----------- I (Draw existin and-,required addition on reverse side} 9 e! this tapplication'Andi fh t the work will be done in accord Flame ownce with State orJoaquin lic licensed I hereby-certify that.1 have prepar . aQen Ordinances; State Laws; and Rules'_and Regulations of the San Joaquin Local Health Dis r c b S signature certifies the following: '' ( , Jf(jJ 4= "I Certify that in the Performance of the for which this �perrnit is issued, I shall not employ any person in such manner has to become 3subject o rkm Compensation laws of California.'" r Signed- - F ,C� ! — -- s--------Ow _ i- _�._ - --Title r (If other-than'owner) V � t FOR RTM N� E ONLYi ' y* - --------- ---=--- - - :-- - ------- ------1 DATE. -�� -- APPLICATION ACCEPtED-BY ------ -'- - _ ^°`T - D1VISION OF LANDM - - - - - k --- IONAALCOMMENTS------ '------------------ ------ ------------------ --- -. --- - -- -- -- ADDITII _c.---- --------- ------- - ---- ----- -------- a Dat --- ------------ _ - e - Final inspection by__.____.__ ____ ---- F&S 21677 REV. 7176 EH 13 24 SAN JOAQUIN LOCAL HEALTH DISTRICT