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FOR OFFICE USE: FOR OFFICE USE: 'PLICATION FOR SANITATION PERMIT �/ -- ---- ------------------- --------- ---•- � '.y Permit No. .. ---- (Complete in Triplicate) ----------------------------------------------------- Date Issued__._' --.-.--_ --------------__,.-.....- ---- .--- _.__--___-_ .___._.This-Permit-Expires 1 Year From Date Issued 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 Ordinance No. 549 and existing nRules arXl Regulations: a 0C�r � AX JOB ADDRESS/LOCATION.... _.CENSUS TRACT ------- ------- ----------- -------------- ----------Owner's Name. .............. a Phone Address - /�CCy/it�tA!.- a/ i City Ti-Hc,Y--------------- -----Zip-------------------- -- - -- Contractors Name 0+._.�/IcTh&eykz..'f Sia _ _License # L6f'� -- Phone,4Ao'.` �� Installation will serve: Residence ❑ Apartment House ❑---'Commercial J!9 Trailer Court ❑ Motel ❑ Other------------------ ------------------._.. Number of living units: Number of bedrooms----- ------Garbage Grinder------------Lot Size------------------------- ------------------------- - Water Supply: Public System and name--------------- - ------------------- -- --- ----- --------- --- ------------------------------------------ ----------Private ❑ Character of soil to a depth of 3 feet: Sand ❑ Silt❑ Clay ❑ Not❑ Sandy Loam ❑ Clay Loam ❑ Hardpan ❑ Adobe❑ Fill Material........_.-If yes,type----------_----_-------------- (Plot plan, showing size of lot, loc8tion'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 I ] SEPTIC TANK [ ] Sae ;_,-_ ------------------------- Liquid Depth r' --.- Capacity jf-l�4-_-__Type *ej*G Material -' GOAVA- ---_ No Compartments.. 8 Distance to nearest: Well ..44. act r - -_ _Foundation---sG ...... Prop. Line Ar ..-- LEACHING LINE [ ] No. of Lines_ may---------------Length of each line: /er-- _-------Total Length-_A.:00 'D' Box------- ----Type-Filter Material- !f;t°r.._ Depth Filter Material-_!�-------- --------------- -------- P d r- tion_ -"- ------------Property Line.- /So'-- Distance to nearest: Well t2 ---- SEEPAGE PIT [ ] Depth...- -____ Diameter Number Rock Filled Yes ❑ No CJ' oun a Water Table Depth------------- -.._. .-_... -----,_-__.Rock Size_ --_ -- _ -- Distance to nearest:-Well ___ Foundation.:- --------------- Prop. Line __-- _-----_ REPAIR/ADDITION (Prev. Sanitation Permit#---_-.-_..._--_--------______._ --------Date.,.-__-_-------------__.__: ) Septic Tank (Specify Requirements)........ ---------------• ---------- --- -------------------------------_-----------•--------------------------------------- Disposal Field (Specify Requirements)------:- ------ ------ -'--'---------- ------------------------------ I � --------------------------------------------------------------------------------------- _---------r----------_-------------------------------------------------------------------------� -- - _.- - - ------4--------'--------------------- -----------------------------_ _-------------..___. �.1 ----------------------------------------------------------------------------------------- - - -- - 1 (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 County Ordinances, State Laws, and Rules and Regulations of the San Joaquiri`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 not employ any person in such manner as to become subject to Workman's Compensation laws of California." Signed d!, A*7 110 Vl. SAH - --- --... _._Owner By.... _....Title - ---- - _ ------ _ ...�- - __ other than owner) FOR DEPARTMENT U3E NLY APPLICATION ACCEPTED BY--- --- - - --- - - - DATE.---- --- ---- -- ------------ `:4;DIVISION OF LAND NUMBER--------------------- -------------------------- + DATnE--------- ADDITIONAL COMMEN 5------ yJ4lsn a -- - .. a .-.� +1--- ^ --- -- - -- - v - - ...............--------- ----------------------------------£ - - - - -- ---------------------------- ------ ----------- -----------C- ---- -- ------ --------------------- --------------------- ------------ ---------------------- -__.. 7 - - Final Inspection b -- - - Date --------------- ------- EN _.- - .. ---------- -- -- - --- P Y° - ;- at 13 24 SAN JOAQUIN LOCAL HEALTH DISTRICT F&S 21677 REV. 7/76 3M