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r FOROFFICE USE: APPLICATION FOR SANITATION PERMIT -------------- ------ --------------------------------- f (Complete in Triplicate) Permit No.. ____ ---.-_------`� --------------------------------------------------------- � , --.,--this Permit Expires 3 Year From pate Issued Date Issued Application is hereb"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 prdinance No. 549 and;existing Rules and Regulations: F JOB ADDFESS;LOCATION .- ------------ � J - CE - NSUS TRACT Owner's Dame - � .�C ��` ---------------- -----------------Phone ------------------------------------ j Address � � E C" --------------- --- city` -t ' / � �.. , C Y- Name - -' ,> �Residen�- �� A a�tme t House°��+ Commerc al5e ---------�ailer Courti4 .----- Phone ----------------------------- Contractor's r Installatio i willserve. 1 ❑ p ..._ n ❑ MotelOther ---------------r- ------------------------ Soo` �------------------- units:-_____-_i___ Num e of be rooms -- _Garbo e Grinder _ _______ Lot Size T r � 4f Number of liv£ng "�, c� g .e � ` � ` � ' '. Sand Loam ' '�� { Water Su,�PIYf Public System{and nam- ------- .-------------- - = Private, a Charactef:soil to a depth of 3 feet Sand Silt❑ Cay ❑ Peat ❑ y ❑ Clay Loam ❑ - f H rc3pan ❑ Adobe ❑f Fill Material __________ If yes, type ___y___ _____-______--- i �. r (Plot plan,~ howing size off [of,'loco ion, of �ystem in reliition to- wells, buildings, etc. must be, plb7ed on reverse side.) r' NEW INSTALLATION: (i\fo septic tank or seepage pit permitted if ublic sewer is available within 2 D feet,) PACKAGE[TREATMENT •SEPTIC TANK� •Size._ 9°�_�__ '� j iJ r 'h' Liquid .Dpth __� ._. �/ ` nts --- -------- Distance Type. ____ �'_ Material /(!_'_ _ No. Compartme Distance d nearest: Well 1 P�-----------------------Foundation -,� ------'------ Rropl ine ---- -- LEACHI6G LINE No. of L`i•�ses ____ _______________ 'Length of .each line_,,f r-_ U. `___________ Total Length f _-____ D' Boaz _ Filter Material- X-.F_-___Depth' Filter Material __ _ ____--------------------------- Type . E ei `1 1 ----------- Foundation s Property` Lir1e 19 i�tarrc� to nearest: Well �, SEEPAGE PIT [ ;Depth " 1 -_ Diam r'lf�__________ Number ____________________________ Rock Filled !es,j� No .❑ # i ,, 11,- rS/d`ater able Depth iF�"'� --------------- -- --- -- Rack Size F Distdnce to nearest: Well .`AIW---------------------------Foundation -------- Prop.`Line _ ----------- REPM#/ADDITION(Prev. Sanitation Permit# ---------- -- ------------------------- Date ---_------------------------------1 Septic Tank ---Requirements) ---------------- = ---------- t Dis;posal� Meld (Spec# ' Re�uiremer `s ------- - �---------- { - ---------- t [ Y . ------------- .� r ; rdw existing and required addition on reverse sidel A,.herL;9�Fyj�,certify that ! have p epa e� this application and that the work will be done in accordance .with San Joaquin "'&un`ty`drdinances, State Laws,a d Rules and Regulations of the San Joaquin Local Health District. Home owner or licen- sed agents signature certifiestthe following: "L certify that in the performance of the work for which,this p.er.mit,is issued,1,shall not employ any person in such manner !, as\to become subject to Workman's Compensation laws"�f,Cal'f-L.rnia.'' Signed " "" Owner—,4 :� l -- -�, - --------- ----- -- Ti'tle' '` t � � ; t (if other than owner) FOR .DEPA1t71,1EN7 USE ONLY i APPLICATION ACCEPTED BY --------------------------------------------------------------------------------------------------. .SATE . -- BUILDING PERMIT ISSUED --------------------------- -------------------------------------------------------------- ---------------DATE ------------------------------- ADDITIONALCOMMENTS ------------------------------------------------------------------------------------------------------------------------------------------------------ ------- io- --------------- ------------------------------------------------------------------------------- ------------------ ------------ -- -------------------------- ----- --------- 4I -------------- -------------------------------------------------------------------------------------------------- ---------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------- - ------- � rY Final Ins ection b _ _ Date __.___ __-L _ - _________- -.