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FOR OFFICE USE: I ,p�it+ +�,, *' ` r R OFFICE USE: APPLICATION FOR SANITATION PERMIT �ii+r'i> Z= _ ------- -------------- --------------------- - Permit (Complete in Triplicate) --------- '---.-.....---------------------'------ �•_ Date Issued.111:�.1-�'� _/�................._-._. -.. This Permit Expires 1 Year From Date Issued Application is hereby mode to the San Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in compliance r�with County Ordinance No. 549 and existing Rules and Regulations: J �--- JOB ADDRESS/LC!G_ JON_. A&PY ------. ..- _-40' _--------__.. . - ___CENSUS TRACT_!'4 ------- Owner's Name - .-_ Phone..- . Address--- 7J`------------ -- •- .f ... . _.City. ----- -Zip Nome-_,b---Contractor's Nome_ f --------------------------------License #_�ll.S"% V----Phone--------------- -- Installation will serve: Residence Apartment House E] Commercial ❑ Trailer Court ❑ Motel ❑ Other-------------------------------- --- Number of living units;---f--------Number of bedrooms__'__ _.Garbage-Grinder_--_._--Lot Size---�diw"ae....I-------_-----_--- ----- Water Supply: Public System and name------------------------------- ------------------------------------ .................---------------------------------Private 2r, Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay❑ Peat❑ Sandy Loam Q.' Clay Loam❑ Hardpan❑ Adobe❑ Fill Material_----__ -If yes,type------------------------------ Q (Plot plan, showing size of lot, location of system in relation to wells, buildings,etc. must be'placed on reverse side.) NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK [sJ-- _X/i? - �r � ------------Liquid Depth:-5.?------------- Capacity- QQ_ Type-J --------Material-_C,_�x�.--.-_--.No. Co portments-----2-- 7 a r - Distance to nearest: Well- `__��_1..Foundation-`__.______.Prop. LLii+ne__A.7�--___ _. LEACHING LINE h _ No. of Lines__-�C-. _ _---Length of each line__4M— Total Length ----- ____________� �- 'D' Box #Type Filter Material� / � _-- epth Filter Material..... ------- -- a y� Distance to neare�st�: V � <«Foundation--.V/10L�_------------Property Line--. -4�6p- .------ SCiPFtGi! PtT [ 1 Depth-�it-�-- aeister - -Qs _ :-------_.Number_-Number_____. -2 __------------- Rock Filled Yes No Water Table Depth--------bl. - ---------------------------------Rock Size_. '-_ Distance to nearest: Wel(--o gy p ---Farndation-_.- � / --- - - ---------------...Prop. Line------------------ REPAIR/ADDITION (Prev. Sanitation Permit#- -------------------------------- ---------- Date-----._._.__—.---------------------.) Septic Tank (Specify Requirements)-------------------------------------'---------' Disposal Field (Specify Requirements). -------------------------------- ------------------------------------------------------------------- (Draw existing and required addition on reverse side) I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin Count, Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District, Home owner or licensed agen signature certifies the following: "I certify that in the performance of the work for which this permit is issued, 1 shall not employ any person in such manner to become subject.to Wor an's Compensation taws of California." Signed --- ----- - - ------------ - __ _.-.__.-. -.. -.._Owner By---- - -_� '"_ ------Title..- C� --- y( (If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTEDY--- �------ --------- - --- ---- -------- --------------DATE..- �Lrc� 'ISION OF LAND NUMBER---------------- ----_--------- ----------------DATE----------------------- JITIONALCOMMENTS-------------------------------------- ----------------------------------_----------------___............. -------------_----------------- -------------------------------------- -------- ------------------------------------------------------ - - -- - - ----- - ------- - --- ----------- ------ - --- ---------- -- - - - Final Ins ion b ni 17 24SAN21677 REV.7 SAN JOA UIN LOCAL HEALTH DISTRICT