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FOR OFFICE USE: - - APPLICATION.,FOR SANITATION PERMIT J ----- ---- Permit No.. --------- --------- {Complete in Triplicate) ------------ -- --------- This Permit Expires ] Year From Date Issued Date Issued Application is hereby made to the San Joaquin Local Health District for d scribed.-Th is,application.,is made in compliance with County Ordinance No 549 and existing Rules and tandtRegulations: he work rein JOB ADDRESS/LOCATION i _�.dL�..�_ -- `�I-�?7C 1 1 i1 i' ,r �y_ -- --S`"CENSUS TRACT -------------- Owner's Name �.��.. �' ------------ --'� � � - --- --�Cl�-----�--�+ �c _: � Phone - - � . Address . ---------- - ..-� \ I-.....-- ------ Cit r Contractor's Name --_------ Q L' License #J- -./-j __ Installation will serve: Residence artment House 0 Commercial:❑Trailer Court ;❑ Phone i Motel ❑ Other Number of liviyg units:---..------ Number of.b ooms --_ l � - Garbage Grinde �rS____ Lot Size �_o�!"- ------------------- m P ! ---------------- i Water Supply: Public System and name _.-_- c � f t •-Lie{ = ------------------------------------------ ' --- Private ❑ Character of soil to a depth of.3 feet:. Sand' ❑ Silt❑ Clay ❑ Peat❑ Sandy Loam .❑ Clay Loam:❑ ' ♦- Hardpan ❑ Adobe ] Fill Material_- v-0 ifs Y,etype ---------------------------- (Plot ---(PIot plan, showing size of lot; location of system in d l relatio NEW INSTALLATION: n to wells, buildings, etc. must be paceon reverse side.) � {No septic tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT ( I SEPTIC TANK .t / i Size_--� �`f--------------------- Liquid Depth _--�---•.----- s� p �.. 2 a gcrty ._ -�- Type '"ice----&-I- ~ Materia[_ ' 4 �- L-LJo. Compartments -,:>............. t �' Distance to nearest: Well -._____-______ __ --_ ----=: .Foundation ---------- Prop. Line = f------- LEACHING LINE [, No. of Lines h �. -- Length 'of each line ; - Total Length ,-`- U__-- t 'D' Box Y_C__.�_ Type Filter Material )/f!'..?_'_'_/4!- pth Filter Materia! Distance to nearest: Well -.--:..'_---______— Foundation -----•-..�� __ . �__ -__— -�--� -- Property Line .5��---- --•- - - SEEPAGE PIT /.-• .- _ ._ ___T �� -- ---- ry( Depth ----_---- Diameter I Number ---I -------------------- Rock Filled Ye No No .i❑ '� �' Water Table Depth _----_--_- _r__ i -- Distance to nearest:Well --_---__ / __ ` Rock Size -__ /2_-�' .___ ------ Foundation ....SCJ-------- Prop. Line --- -� ____ ` REPAIR/ADDITION(Prev. Sanitation Permit# --------------- -- (� - ----- -------- ------- - Date ------•---------------------------) � + Septic Tank (Specify Requirements) -----_------- --------------------------------------------------------------------- ----------- isposal,Field (Specify Requirements) ------------------ r -------------------------- -------------------- ----------- ,.� --------------------------------------- ----------------- (Draw existing and required addition on reverse side)-------------------- ------------------------------ ------- I hereby certify that V have prepared this application and that the work will be'done in accordance with San Joaquin + County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner or licen- sed agents signature certifies the following: "I certify that in the perForrnance of the work For which this permit is issued, I shall not employ an as to become subject to Workman's Compensation Laws of California." P y Y person in such manner t Signed ------- ----- -------------------------------- -- ------ --------- Owner BY { l Title `7�C `/� a(If other than owner] r FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED 8Y --------- -------------------------------------------------- -- -------------------------------- DATE D1NG PERMIT ISSUED _----_�� 7 ---DATE -------- .2 5�. _p�c. - ---- -------- - -AL- COMMENTS---�- - -----== -- ---- ------- - - - ------------ ----- - - -------------- - . t----- ------------------------------------------------------------------ ------- Fina! Inspection b p Y `---- -------- - --Date _.. w SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 0 1-'b8 Rev. 5M. G �