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` FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Triplicate) tr�� Date Issued -- - -- ------------------------------ This Permit Expires 1 Year From Date Issued --------- ifih County Ordinance No. 549 and existing Rules and Regulations: lication is hereby made to the San Joaquin Local Health District for a permit to construct and install the work erei App application is made in compliance described. This app -------- e f- -------- ----------- --------CENSUS TRACT ----------- a JOB ADDRESS/LOCATION J - - 0-AIA-4k --_Phone Owner's Name -�.'9 f= �` -------------------------------- - -------- city ------ i �f Address rCll ' ; ------ Phone ;cense / ----------- Contractor's Name .- Residence �Apartment House[] Cornmercial OTrailer Court ;Q installation will serve, Motel ❑Other -------------------------------------------- -------------------------------------------- Number ------------------- - Number of living units:_._/----- Number of bedrooms - v--___.Garba_ge Grinder _--_---_--- Lot Size -_-------- --- at ---- Private Public System and name --------- - ------------------------ -------- Water Supply-. Peat Sandy Loam E] Clay Loam .Q Character of soil to a depth of 3 feet: Sand'( Silt❑ CIaY. Y e ------.--------------------- Hardpan - __- ----___.__- Hardpan ❑ Adobe � F;II Material _-,___- --_-- 1f es,type Ilaced on reverse side.) Ian showing size of lot, location of system in relation to wells, buildings, etc. must be p \ (Plot p iit permitted if public sewer is available within 200 feet,) NEW INSTALLATION: (No septic tank or seepage p' p _ j Liquid Depth -°` `- --- i SEPTIC TANK I I size_`"��-��`---- p PACKAGE TREATMENT { ] �C'/e�o. Compartments -.--------- �_ Material� '-- Capacity / Type f--=---- r� Foundation __�-�------ ----- Prop. Line ---�------------•-- LA ---------------------1 Distance to nearest: Well -----�-- - _ .............. Length of each line-_--.-7- .d ----- Total Length -,f- I LEACHING LINE [ ] No, of Lines ----------- ---- �r 'D' Box __---------- Type Filter Material 1 �' _Depth Filter Material --- -- Distance to nearest. Well __t'� ----- Foundation -.-�Q------------- Property Line-------------------- s' Rock Filled Yes ❑ No Depth _ Diameter ---------------- Number ----------------------------- � SEEPAGE PIT [ ] p --- -------------- Water Table Depth --------------- --------------------•-----• Rock Size Pro Line -------------------•-- Distance to nearest- Well ----------------------------------------------- ---•--Foundation ------------------- p 4 ' ------------ ----- Date ----------------------------------) ---------- REPAIR/ADDITION(Prev. Sanitation Permit s# _-------� ------ ------ - __ •-_-_ - ----------------------------------------------- - Septic Tank [Specify Requirements) ------------------ - --_------_ (Specify Requirements) ---------------- I Disposal Field (Sp y 9 ---------------------------------- ------------ ----- ------- ---- . [Draw existing and required addition on reverse side) rk will be done in ce h Son i I hereby certify that 1 have prepared this application and th sof the San Joaquin Local Health Distri ct. Home� tHomeowner or (cen County Ordinances, State Laws, and Rules and Regulation sed agents signature certifies the following: permit is issued, 1 shall not employ any person in such manner "l certify that in the performance of the work for which this p as to become subject to:Wo5rk !5Compens�on laws of California." Owner Signed -- ----------------------------------------- -- Title - ---------------- -- By (lf other than owner) F R PAitTMENT USE ONLY DATE ---s.--- -------- APPLICATION ACCEPTED By -.---DATE ------------------ BUILDING PERMIT ISSUED --------- ----------------------------- ---- MMENTS ----------------------------- - - ADDITIONAL CO --------------------- --------------- ----- -------------------- ------------------------------ ------------ ------------------------ ------- ---------------------------------------------------------------------- -------------------------- ----- ----- C- , r-------- -------------------- Date - Final Inspection by: ---------------- SAN JOAQUIN LOCAL HEALTH DISTRICT