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FO OFFICE USE: FOR OFFICE USE: ` ~ APPLICATION FOR SANITATION PERMIT 1 - ----------------------------- Permit No....7_ y N,- (Com.plete-in.Tripllcate)- t Date Issued._ ------ This Permit Expires 1 Year`Fia n Date Issued 1 --=-- t Application is hereby made to the San Joaquin Local Health District fora 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: JOB ADDRESS/LOCATIONl-: .y _. ----.CENSUS.TRACT.,.-._--------- ---- -- ---- - I . i Owner's Name . ,:. -----Phone ---- . - I------------ __.. - Address -o�of ---- City - Zip - � ... _.n.. - Contractor's Name ! ' -- Lice'nse .# 7fs-_ ------Phone '?� �."�Gf- ------ Installation will serve: ; Residence`; Apartment House ❑ Commercial 0 Trailer Court. ❑ h.".�.;. Motel .0 k Other----.,----:.. ...... ...... .. _. .i.. 4- Motel , Number.of living units:_ _._-Nurriber.'of.bedr omsl- G rba Grind __i______.Lot:Size� o"d---X/�--------------------- i - = -------------------------------------- Privat eJ Water Supply: Public System and name__.. r� `"------- Character of soil to a depth of 3 feet:? ,Sand ❑ Silt E] Clay Peat ❑ Sandy Loam❑ Clay Loam ❑ j [. . Hardpan Adobe: -' Fill Materia --------------type ___ (Plot plan, showing size of lot, location of system in relation to-wells buildings,:etc."must be placed on reverse side.) NEW INSTALLATION:` (No';Jseptic tank or seepage pit perm' fitted=if,public sewer is available within 200 feet,) 4. Li Liquid 'Depth., ---------- PACKAGE TREATMENT'[']'w SEPTIC TANK [ ] _"` ..�" . . Size._ �"°''--------------------------- q P ---------- Capaei#y- = = 'T:TYP? = = Maul ------ No--Compartments---- --------- --- ( -------:_-Prop. Line-------------- =---------- .,_...'Distance to nearest: Well------------- --;-- -----------:-�--:--_-:_--Foundation--:--:-----___.-- LEACHING LINE, [ ] No.,of-Lines_:-----------`-'___----_. Length of eaeh,,line._= .-.-_"-=---- --------- Length:---_--------------------- ;-- YP F = t''D' Box _k -Depth Filter Material Distance to nearest. Weli_ _-_._-:..__ y _. T" e Filler Material:-_ ' -- Foundation = ` Property Line SEEPAGE PIT [ ] "Depth----'------'----Diameter------------- -----Nu' ber._:------'--.----.-..-=- -'- Rock Filled Yes ❑ Noy❑ }.. �.Wat�er-Table` - -------'`�''----------- -- Rock Size- = = --- ----------- REPAIR/ ---------- r Foundation------------------ -- Prop. Line --------------�- Distanceao nearest: WelL_.. � .:-----------_-------- REPAIR/ADDITION (Prev.-Sanitatibn Permit#.-__ ._-.-. -. a -----------} - _Date __: ------------------ ± Septic Tank (Specify Requirements)----- ;-'°, --------- - ---------------- =- - - - ----- Disp al Field Specify Requirements):L��6 - --- -------- -_-- _ �.. r --- -- --------- --------- -- - -------- --- --------- -------- ---- --- ` -- '"- (Draw existing and required addition on reverse side) T i t-)I hereby certify that) have prepared this application and that4he`,work will be done in`+actor 'Joaquin.County Ordinances,: State Laws, ancJ [lutes 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 permitAs issued, 1 shall not employ any' person in such manner as to become 's bje t to W man' .Compensation law's of. California;'. l i Owner€ ed---- ----------------------------------- sign i BY--- -----------C-- -(a�-��' - -------- - --- ---------�------ '-Title -^ ---- #• (If other tha-1 ner) t. FOR!DEPARTMENT USE ONLY ' APPLICATION ACCEPTI=D-BY.�..: i - - - DATE. —J DATE------- -------4--- ------ ADDITIONAF LAND NUMBER - ; DIVISION O ' ------------------------------LCOMMENTS-------------- ----------:---- ---vim" -------------=------=---------------=---------- ------`---------'- ---- ------------------------------------------------ T ------ ------------------ ------------ k f '*- ------------- ----- #------------#------ ------------'-- ------------- ------------------- --- ------------ -- - I ---- --- -------------------------------- ------------- _ ---------------------------------- --- -- - -- -- _ ---------- -------- --- - ; I Final Inspection- yfn,_.. . _ ---------------------- Date °7 ? EH 13 24 SAN JOAQUIN LOCAL HEALTH DISTRICT Fos zi6�� REv. �,.