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FOR OFFICE USE: + FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT �- Permit (Complete in Triplicate) Date Issued........ ------ — ............................ ......... This Permit Expires ] Year From Date Issued in Local Health District for a permtit to consuct 6nd.install the work herein described. Application is hereby made to.the San Joaqu This application is made-in compliance with County Ordinance No. 549 and existing Rules and Regulations: ,� �` .................CENSUS TRACT------------------ ------ ------ . JOB ADDRESS/LOCATION. _.. ..... ... ... ........... . Phone.__.. ------ ----• ---- ...--- � -- Owner's Name._ j,._ �.d. . 1[ r r .:. . ... ....... ...-.-.- -...:C...ity........-.--........�- ----�----------_-��--.-.- Zip------- Address = Address t�. Phone... - M-44 { Contractor's Name.... -.-- ? � p - License #.gypl /.. Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ . Motel El Other.. - -.-.---,--�-.- �- ../ .. /. 90-_..----- age Grinder--_. Lot Size..--- r of bedrooms rb Number of living units:.. -./ NumbPrivate ❑ Water Supply: Public System and name.. _ I Character of soil to a depth of 3 feet: Sand ElSilt ❑ Clay F-1Peat ElSandy Loam 0 Clay Loam Hardpan 17 Adobe ❑ Fill Material.. If yes, type-_- {Plot plan, showing size of lot, lacatior'of system in relation to wells, buildings, etc. must be placed on reverse side.). ti NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available v�ith'Li20 Liquid )th. .Size-- ! q p PACKAGE TREATMENT [ ] SEPTIC TANK [ ] x v' No. Compartments- __ - - .. --..,Material_.. - ��------- ------�------- Capacity..j..�.LO.Q..Type-,4.--� { - ...Pro Line........ .... ...........\ ., Distance to nearest: Well...---------`------ - -- ------ --------- Foundation------..- p Length of each line Total Length ... - �. --- LEACHING LINE [ ] # No. of Lines ._._ 'D' Box--.:- .,'.Type Filter Material...../��, --.Depth Filter Material...'.�. .�-_.... Distance to nearest: Well------------ -- Foundation =--- 4-..Property Line �x /0 Rock Filled Yes ❑ No SEEPAG� PI't [ 1 p � De h.....-. - --- Diameter. ------•---'-- ....Number----- ------ - - - Size.._.""".. Water Table Depth------------------•----- - ----- -• ---- Rock -• - -Poon t -- -- -- - ----- ation--- ----.,_......_ .- ...Prop. Line.----.-- Distance to nearest: Well..--------- ; { Date------- _•-._... ----- --- REPAIR/ADDITION (Prev. Sanitation Permit -------�--�--�------ - ------ Septic Tank (Specify Requirements)_- .....------- - - Disposal Field (Specify Requirements)f. • -- -------------------- + i x b: ....... 1 ....... --------...-----;------------------.------------------ .-.------------------.--------------.-.-..--------- --------- __ . .. ... ...------------ ..................---------------..._-------.------------- ----------------- ...... ..... -.... ................................... ...........'.._. _ 'l (Draw existing and required addition on reverse side) I hereby certify that l have prepared this application and that the work will be done in accordance with Sun Joaquin County rdinances, State Laws, and Rulesty P 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 permit is'issued, I shall nbt employ any person in such manner as to become subject to Workman's ompensation laws of California." ...Owner t Signed.. -- -- -- Title.__..... (if other than owner) Ir FOR DEPARTMENT USE ONLY s DATE .....G.._.12'� l APPLICATION ACCEPTED BY- -`-- - - - DATE__ - -DIVISION OF LAND NUMBER ... f .... ADDITIONAL COMMENTS_--- / --.2�-,a.Q�- fa��" l ... .. - ..Date --- _,KA�x-;;/�--- . Final-inspecfion by__. .....---j/-----F--- -- - Fos 21677 REV. 7l7e an EH 13 24 SAN JOAQUIN LOCAL HEALTH DISTRICT