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FOR OFFICE USE: FOR OFFICE USE: ,��y1� APPLICATION FOR SANITATION PERMIT �] // (Complete in Triplicate) Permit No.._._ '_____ 3S i Date Issued.77_`)-T_?( ----------------------------__---- _----- --- __ --I This Permit Expires I Year From Date Issued I Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinan o. 549 nd existing Rules and Regulations: JOB.ADDRESS/LOCATION =} -� - CENSUS TRACT- . , a F - -------ti---- Address �._ d 7 _:';: --- ---. ------------ ----- --'City- -------- --- Zi Owner s Name. .. T:i �.. . ..... ' ;;:::: -_ Phone- .._. 7 �., _ _ - p Contractor's Name - r�-�? l ------=--- ---------=--------------License # 12 . 41 - ' .Phone:_�`S_"_A)-�f -.. Installation will``se e: Residence Apartment House❑ 'Commercial ❑ Trailer Court ❑ E Motel ❑ ;Other----- = = - ------ T i Number of living units::!7/-_,_! -__Number of bed rooms .`Garbage Grinder __--------Lot,Size - _: 4-- Water Supply: Public System and name -.-- - ---, ` ?' -- —. -- ----------------------------------- Private Character of soil to a depth o{3 feet: - Sand El Silt El Clay ❑ Peat❑ Sandy Loom E] 'C14 Loam ❑ i - 1Hardpari❑ Adobe FiII Material__...._..-._Jf ye$, type - ------------- - - (Plot plan, showing size of lot, location of system in relation to wells, buildings,'etc. must be placed ob reverse side.f ] NEW INSTALLATION: "(N6",septicffank or seepage pit`permitted'if public sewer s'availab]e within 200 feet,)' PACKAGE TREATMENT•..[._].:SEPTIC-TANK''[. ] Size-----=------------- --------------------------------------'=(TtTid-Depth------------------------ a Capacity----"- --` TYpe =- '-- Material == -- ------ -" No. Cort partments ._r Distance to.nearest: Well.--':--_ --Foundation---- - -----------------Prop. Line------y =-------------- cE ` LEACHING LINE: [ I... No. of Li_ne's------------------- -------Length of.eoch lina.---------_`-----_- -----.Total' Length -----------------$-_ _ ----- <3 ' �. D' Box .__._y '_`Type Filter Material ---- -''r -Depth_Filter Material `Distance to nearest: Well---------- - Foundation._'' -- Property line - - .... . .r. _ k.. - --r------ SEEPAGE PIT [ ] Depth\ -.__'- -_.Diameter--:--------- ------Number-----------_---_._.,__ -------- Rock Filled Yes - No i Water Table Depth. -. = - -----.-----Rock Size= '-----------------------•------- ------ ' t Distance;to nearest:'Well'.---------------------- ----------------- REPAIR/ADDITION _.._:'_:_--- ------- __ __ '_.Prop. Line. - --------- . _ = Date----- =------------------ Septic ---------- E � REPAIR/ADDITfON-[Prev:Sanitation Permit#__;____-__ �"__-�____--_ .___._ Septic Tank (Specify Requiremerits)'i" - == I , r i - -- - - ------------------ --------------------------------- ---- --; Field (Specify Requirements) " - ( -_ �6 - -- ------ - -- _- -+ ------ Disposal - -------------- - ----- -- ---------------------- k - ----' - - --- -- _ . -- ---------------- - I (Draw existing andequired addition on reverse side) hereby certify that I 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 licensed agents signature certifies the'follo irig: "! certifyThat in the 1 ,�'� * � t $ { performance of the work for which this Oermii-is issued, -I shall not employ any person in such manner as togbecom t to Workma s..Com n troa ws of alifoWwher s"' Signed--.-- .�s '. �__ BY-'----- --------------=------- ---==--------------- - ---------•------------ ---------------------- --- Title.------- ----- ---------------------------- -------- (If other than:owner) i FOI11 DEPARTMENT U NLY" APPLICATION ACCEPTED BY--=---- --------- -------- ©` !-------------------------DATE.----- ----- ...... =- '- ---------- DIVISION OF LAND NUMBER._.. -..,. .------- -- DATE- ---------=------------- - ' ....... --'- ti ADDITIONAL COMMENTS-------------------' ---------------------------------------------------------- - - - ----------------- ---------•---------------------- ------- --------------------------------------- --- -------------- ------ ------------ -----------------------:-------- ---------------------------------------- --------------- --•-"--- ---- `------------------------ ------------------- '-------------------------- ------------------------ ------------ ------------ --- f,� -' - '------------ Final Inspection b -.-_ --_ _. --Date��_ _.�C.�--------------------- -- p Y' --------- EH 13 24 SAN JOAQUIN LOCAL HEAL TRICT F85 21677 REV. 7176 3M