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FOR OFFICE USE: FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT � Permit Na____-_-_--------- ----------------------- (Complete in Triplicate) A= Date Is5uecI4_--o24 --- _- This Permit Expires 1 Year From Date fssued Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. mpliance with County Ordinance No, 549 and existing Rules and Regulations: This application is made in co +!� r = C� NSUS T A CT � -- -- --- ,----- JOB ADDRESS/LOCATIO3Phone - - --- ------- -------- -- 'Owner's Name.-- Zip - - � 16 ` City 5 -- --- --- --- -- - �Address Phone.- ------ ---- Contractor s Name--:--- CLicense # s� Installation will:sarve: Residences Apartment House.❑ .Commercial ❑ Trailer Court'❑ �. F Motel D. .Ot�h/er_ :% ---- ---=---- -------='--------- �. Number of living un+ts---=------------ Number of bedrooms_:_--T__-Garbdge Grinder...-;-_____:_Lot.Size__.___.__-,.______.___._.___._ r - vat i -, ---P name--- ---- -----------------;-- Water Supply: Public System an . Character of soil to a depth of 3 feet: 4 Sand ❑ Silt ❑ Clay ❑ Peat ❑ Sandy Loam� Clay Loam ❑ ' a Fill Material.--.-------_If es,type-- ---- Hardpan ❑ : Adobe.❑ Y (Plot plan, showing size of lot, location of system in relation to wells,'buildings, etc. must be,placed on reverse side.) + NEW INSTALLATION:' ' •(No septic tank or *seepage it ermitted if public sewer is available within 200 feet,) �r i_ __ . P P , r SEPTIC TANK [�}� Size_ x(? � /O�ZLiquid Depth__. ----------- 11147 PACKAGE TREATMENT [ 1 / Z Capacity'=-C-�oc> _...:Type---,-�" `'= Material~-� _' --"-----._:No. Compartments. v P, 0- --=------- _ _ Eoundation. ---=-- -----=--Prop: Line---- g ` / j Length._ _--l °-- Not of Well --- ---- ---------= '/ = Q, LEACHING LINE; Len th-of each linea - - 4 !� De th�Filter Material E - `Z o a. D' Box-/�- --Type Filter Mater+all -x---- ,:. I? .. } - r' - 1�� __ v��- -' _ _Property Line ----------------------- -: Foundationi Vstanceto nearest: Wei I-' !. ------------ ...r. . �� f e N De th_ o? s `f "7- .Number__} �' - 3 '-- Rock Filled Yes�% o ❑ SEEPAGE PIT 11 P ---Diameter .._ . __ l ( f / �1� --------------------------- ----------- - --- ---- ( t ' ---- -----=---.Rock Size------ -- �? . fi i + ---------- Water Table neaeesh:"Well : . --: ©- f Pro Line---d`-'-------------`- w y -�=----- Foundation = P- I D+sta � � + - + , ' -------------------------- Date--_ =_ - } F - REPAIR/ADDITp10NYPreq. San+tation Perm+t#___'_�, -'--=---- ------- � f --------- .---------------- Septic --=-- -------- ------ ------ ------- - Septic Tank (Specify Re uirements)._-- ---------- --------------- ' - - /- ---_- %- --- ----- --- -- -% - I -- - --- --- - --- - - Disposal Field .{Specify Requirements]: .___ i__ -------------- Y1, k � - -------- --- ---- i ---------------- -- -------- _ -- - - - 9 _ ! _____________________ ___ --------------__. ___. iE ------------ - - -- ------------------ ---- -- --------------------- t ; (Draw existing and requiied addition on reverse side) I hereby certify that I have prepared this application/and{.th t the-work-will--he-done-in•-accordance with San Joaquin County Ordinances,- State Laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner or licensed agents signature certifies the following: c� rerson in such manner as "I certify that iri-the performance of`the work for whiilh this permit fir issued, I shall not employ any p f to beV_'subjeto Work an's_eCompensation,-laws of Califorr�la." i. t. `1 Signe ;-------- -- = T I �SP.C� , •� --�---- -Owner I ` it e__v_ t u i - f other than owner) i SE ONLY; FOR DEPARTMENT'U . . x 10 APPLICATION ACCEPTED BY--- ------ ------------- )!113 ._� --- '� - -•---------------------`�-`-I-----=� --- i--- ------ --------- ------- -------DATE---.--- •------- --------------------- DIVISION - --- --.-.--- -- -I DIVISION OF LAND�NUMBER. = ' `Y ^ x' ----- -------------- ----------------------ADDITIONAL COM.I�ENTS ;_ =.-------------------------------- ----------- -------- ------------------------ -.-- -------- ------------------------- -- -- ------=-----=-----= ---- -----=-- - --- ------------- ----- I I - -M - ----- __ - ` _ ------------- � - Y/ -------- ----� -----Date.- . �i. 7 Z Final Inspection-by.:----==----�_--- -- --- _ I` F&5 21677 REV. 7/75 3M EH 13 24 I SAN JOAQUIN LOCAL-HEALTH DISTRICT