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FOR OFFICE USE. FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ......................................................... (Complete in Triplicate) Permit No....�. .'S 1 y ..........I............ .....................----------- Date .... . Date Issued. .......... ............................................ This Permit Expires 1 Year From Date Issued 1 Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein describe This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: ., .. _ _....._.,. _ .. ._ �t - : j� 1 JOB ADDRESS/LOCATION �t-r /--.-.--�-- CENSUS TRACT.----•---.------..•-.•- Owner'3 Name------- �!C.- i: '�'�•---- ... Phone. Address................... --. ..--- ---- <^ City------ .............. ............•-- ..h o Y•.q, s .� { Contractors Name-- ...... License #..3�_5...Z'�"t�.Phone.__.... :. Installation will-serve: i Residence Apartment House.o. Corrimercial ❑ Trailer Court❑ .... .� . .i .. . .. ...... Motel ❑..: Other -._:..:.. :. .. ......?............= =----- e; Num bei of•living units.,...- ----Nurnber.of bedrooms'-.:-_--.---Garbage Grinder..............Lot Size_.....�-----.~_----!'------ ---`"---+.---------- Water Supply: Public:System and'name-:-' ..................... : ..... ------ :: ------------------- ................. --.Private Character of soil to a depth of•3 feet: Sand ❑ Silt ❑ Cla.y D Peat EJ =Sandy Loam Clay Loam ❑ ' Hardpan ❑•. Adobe.❑ FiII Material... y ' I If type-.- --------------- ------ (Plot plan, showing size of lot, location°of system in relation to wells, buildings,'etc. must be placed on reverse side.) I NEW INSTALLATION: (No`septic tank:or -seepage .pit permitted if public sewer is available within 200 feet,} PACKAGE TREATMENT J + SEPTIC TANK [;.j, '`� 'Y Size------------------------------------t---_-:--------:r:=.._Liquid Depth- ............. ------ :......:....:_'Type.:----:---:_...:.... --Material_........ ...- Capacity..... Compartments_._:....-•-•----------- -- i • ...:Distance�to nearest: --------------- ..................uj ..;_:..-:€.----•'...Prop. Line-':i...... ...........•- LEACHING LINE [ ] No. of,Lines_..._ __...............:.:...Lengfh of each`Line.__:........._,,:__�;;:_.:.....total Length._.._...._._._____-__:-.__.______.- D' Box_.:-........Typ`e•Filter Material;..............:-- Depth Filter Mate`rial_...............:... ...-.------------------..------ ! Distance to nearest: Well.:------:............. -ftuTliitlutioT --'----t------ :. ---.Property Line----------------------------- - SEEPAGE P17 [ J Depth....:......:....Diameter-,__....--- -=....Number---:--------------------- _--- Rock Filled Yes ❑ Nc .r. ..•4 • ... • . .. Water Table'De•nth------•-•---•............. ...:....•- ---.._...__.:.,.._Rock Size: e' ' , _-.-:.._...-Distanctoneares1 .�"..-:.----':.:- Line--------------- ...... REPAIR/ADDITION-(Prev. Sanitation Permit#..... Date-------------------------------------------- Septic Tank (Specify Requirements}------- ----- .............. --------------------------------- •--- .. ....................................... Disposal Field (SpecifyRequ'reme s) C ------------ C .,._ ....Q-?� - l' -- ___ ____ __ _ ____ __ .._.. .......... °----- -:------........... •--•-••---------••:---__.-------: w (Draexistingand required addition on reverse side) I hereby certify that l have prepared this:application and that the work will be done in accordance with San Joaquin Coe Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner or licensed ag, signature certifies the following: "I certify that in the performance of the work for which this permit 1s issued, I shall not employ any person in such mann: to become subject to Workman's:Com nation. laws lifornia." . Signed....--- •----- i t - • . ..... ....... Owner _.. .....--- - ' (If"other than owner) ; + FOR DEP TMENT USE ONLY -_. -• • ---•---------------'-----•------- ----•---. .._.... APPLICATION ACCEPTED BY::._. ._ DATE DIVISION OF LAND NUMBER:----.... -:-- • •-•--- DATE.. ADDITIONALCOMMENTS :......... ........ .......................................:........................................... . g -- ------ �_ _._...... ------.-•-----�--�'" - Date . ._ .._ Final Inspection-b EH 13 24" SAN JOAQUIN LOCAL HEALTH DISTRICT Fes 21677 REV. 7i