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�t{OFF{CE USE;„ ,/ FOR OFFICE USE: ' �' +r APPLICATION FOR SANITATION PERMIT Permit - t .(Complete in Triplicate) - = r ` Date Issued-/40,9 7_ � ......... t This Permit Expires 1 Year From Date Issued 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: R 7 ..-- - CENSUS TRACT r JOB ADDRESS/LOCAT N.---_"i. ".. ;--- dl Phon Owner's Name .. .. .. ...... .-. e- `�` . ,...^ / �� Address - .�/�!/ ..�..-. Y zip--- Add . _..- Cit rs3 Contractor's Name...... - `� . .......... -- -License Installation will serve: Residence E] Apartment Mouse ❑ omme sal ❑ ,oiler Court El Motel E] Other..._. --77 Number of living units:................Nbmber of bedrooms. ..........Garbage Grinder............Lot Size.-.-------..-..... - . LLPrivat Water Supply: Public System and name'. ------ -------------- ---.....--------"-------------- - -------------- ay ... e E�;Characfier of soil to a depth of 3 feet: Sand ❑ Silt ❑ Clay ❑ Peat E] Sandy Loam E] Cl°Y Loom ❑ ;4 Hardpan ❑ 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 (eJe•rse side.) NEW INSTAL;ATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) / PACKAGE TREATMENT '( } - --- — �- Size..... s/` --- -Liquid Depth.-.................... dr1 SEPTIC TANK � �-- .---• --•--- ------•---- - -- - - - / Q T -:...Material L No. Compartments.._ CapacitYi/��- Yp . r Distance to nearest: --- .f•Foundation./d. ......Prop. Line...��__. ` �QQ Total Length ...., . LEACHING LINE No. of Lines ... _ ...--------------Length of each line .. ..- .•------- t D' Sox_.......... Type Filter Material. i ��lDepth Filter Material---_ .. ----- c!� 0.-�--- Property. Line_.--- -- �`.... --. Distance to nearest: Well- OQ-: .,t-- ---,Foundation'..... ... t cPAGE PIT _ [ } _ P :: i Rock Filled Yes ❑ No �r ._, De th.. ..... .......Diameter.-.-""�'-- Number ----- '---------------- Water ------- ; - ---- ;� - Water Table Depth-------------------- --- --- - ------ ------------------Rock``Size.......... % .........I----------- Distance to nearest: Well.-------------- ------------------ -- Foundation`_ ------ .....Prop. .............. a -- ---.._.-.Date--------.-•---..'....- REPAIR/AUDITION (Prev. Sanitation Permit#--------------- �------- --- -- - - Septic Tank (Specify Requirements)_-_ -- --- ------- •------------------- ------ --- Dis osal Field (S e-cif -Re uirem-entsl..:_...---..=_ - --- ----- --------• .- .. --------- - ---------_--:- __ ............ -- --- ._- ...... ......... .. - �. (Draw existing and required addition on reverse side)-,t � . � I hereby certify that I have prepared this application and that the work will be done lin accordance,with- San Joaquin Co Ordinances, State Laws, and Rules and Regulations of the San Y Y ,Joaquin local Health District. Home owner or licensed agents signature certifies the following: "I certify that in the performance of Ithe work for which this permit is issued, 1 shall not employ any person in .such manner as i to becosu )ect to, War n's C m sensation laws of California." T Signed - _.Owner ,.... ...Title_ ----- --- ------- -- ------ ----- -- -- i (Ifthan owner} E;O"EPARTMENT USE ONLY .. . -. -- APPLICATION ACCEPTED BY----- DIVISIONOF LAND NUMBER.-- ----- -- _------------------ ---- --------------------------- -------------------------- DA -- -- . --- ....-. _.. ,. ADDITIONAL COMMENTS ------------ --------- ---------------------------------------------------- ----------------------------------------------------- ..-- iI- --------------- -- - -- ------------- -.-...... ..... .. ... .............. Final Inspection b - �`-5�`h-t d---------------- ------------------ ------------- y F&S 21677 Rwl_ /11 3M ` EH 13 24 SAN JOAQUIN LOCAL HEALTH DISTRICT (�� ,,