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LFOp OFFICE USES APPLICATION FOR SANITATION PERMIT Permit No: - -:'/�- (complete in Triplicate) Date lssuedj�--a-This Permit Expires 1 Year From Date Issued -- ------------ - Application is hereby made to the San Joaquin Local Health Di Ordinance for a permit to construct and instal! the work herein application is made in compliance with County Ordinance No. 549 and existing Rules and-Rego lotions.-, described. This app I R CENSU T_ CT - - � - - ----------- - JOB ADDRESS/LOCATIO ------ ----- --------- - f Owner's Name --- City =- � � ---- - �Phone ---- - --- - Address ---------------m — r ------.License # �� ' �, �c Contractor's Nae :--- -- Commercial:{]Traile_ r Court Residence ❑ Apartment House�0 Installation will serve: Motel ❑Other - 22- .. tot Size ----------------------------- --- ---- ---- -------- ---- � Private Number,o# living units:.___-�--- Number of bedrooms >-.y---Garbage Grinder -..--------- E ----------------------------------------------------- Water -------------- - --------- - ---- Cla - Sandy Loam ❑ _Clay.Loam .❑ Wafter Supply: Publ-sc System and niame ----------------------------------------------------------- -------- ----.:------ -- - , + ' Silt Y ❑ Peat❑ Characfier of soil to a depth of 3-feet: 5and'❑ I ❑ _---__. Adobe.❑ Fill Material ------------ If Yes,type ---.---- -- --- 1 Hardpan s L4 ' buildings, .etc. must be placed on reverse side.) (Plot plan, showing size of lot, location of system i relationmido f`h/eublic sewer is available within 200 feet,) NEW INSTALLATION: (No septic tank or seage pit permitted', �`P , i Liquid Depth -------- SEPTIC TANK [ Size.7 �1 -------------- q \�{ PACKAGE TREATMENT [ ] eriortments ------Mat - PAC Comp Capacity'-_� YP --- Prop. Line . _Foundation ------�Q-�--- � ---- , t• ' Distance �to nearest: Well -.- ---- � , ��--�- Total Length ,_--idU--_--_---._-- No. of Lines ........� ------ ---- Length_.of„eadl;.line.�'"---..:-:w:- -------- LEACHING LINE LTL---.--_Depth Filter Material ----11------------------------- ----- I 'D' Box .- --- Type Filter Material Line. --------- -. :�_�� --- - Property Distance to nearest Well :y Rock Filled Yes L/� No i❑ 3 ---- Number'=---�--- �-- - �. f` Diameter --- . SEEPS PIT [ Depth . , -- ----------------------- Rock Size G Water !able Depth ------- Foundation ----01Q Prop. Line ---��-------•----•-- • 1 Oq`r-------------- � �l Distancetto nearest: We ------ - � ------------------------------------ Date ----- ---- ----------------------- REPAIRJADDITION[Prev. Sanitation Perm+t ,...: --------I----------------------------- i Septic Tank (Specify Requirements) ------ ------- ----------------------- ---- --------------------- ------------- i _ -- - _ Disposal Field (Specify Requirements) ------------ - _. --------------- - - ----------`---- i -...-.._. �. ._ - --------------------- ----------------------------------- -.__._.._.-_.._._.._. --------------------------. ._.._.-.-..-.-_ ---- --..---.------._._.-_.-....-.._._-.._.-.. , l ---- i (Draw existing and required addition on reverse side) k I rti that I have prepared this application and that the San Joaquin Local oFlealth D strne in danHo ertow owner or 1 cen- I hereby ce fy County Ordinances, State Laws, and Rules and Regulations of the person in such manner ! sed agents signature certifies the following: for which this permit is ! "I certify that in the performance of the or laws ofCalifornia-,issued, 1 shall not emp oy any p as to become subject to Workman's Compensation F Signed -- -- --- ---------- ------------------ -------------- Owner -- -- Title -_- ------------- --- - ------------------- By ----- --- j • Y (if other than owner) i- FOR DEPARTMENT USE ONLY DATE i DATE APPLICATION ACCEPTED BY ( ----------------- ---------------------------------------------- BUILDING: PERMIT ISSUED __-_ --------------- --- ----- ---- ----- -- ---•--- ADDITIONAL COMMENTS ------------------------------------------------------------ - - - - - ------------------ ----------------------------------------------------------- ------ - - --------------- ----------------- ---------------------------- = ------ -- ---- - --------- _- - - - ----- ------------- Date ----- - ---- - - --- - --- ------ -------- - ----------------- - - ----- ------------------------------- by. Final Inspection i SAN JOAQUIN LOCAL HEALTH DISTRICT f -E. H. 9 1-'6B Rev. 5M '