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C e d'" FOR GFFICF ..ISE: t I -r)R !)FFIf F l F4* APPLICATION FOR SANITATION PERMIT (Complete in Triplicate) Permit PJo. -`•:. -- --- ----- i This Permit Expires 1 Year Frons Date Issued Date Issued-:?..-/U -:2 \pplication is hereby made to the San Joaquin Lucal Health District for a permit to construct and install the work herein described. phis application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: i0B ADDRESS/LOCATIOa.r r__ - v- -. - �/ � .•�e�/: ,. -.�5 7-�r.._---__-CENSUS TRACT. . ................. Owner's Nam /- t-- fir ('.�._..-.... .-- ---.. . _ .-.._. - ... -- ------ ---------- - - -_.Phone_-�_�C�O` _.. yddressl.Y .--5-'.-1 `GfkC�t?' � -- Citi, .. Zip — ontractor's Nam _ . -. - .. ......... .... ..__ -------- License # ----- --------------Phone----- -- 'istallation will serve: Residence [] Apartment I I ice tQ Commercial ❑ Trailer Court ❑ Motel ❑ Other/)-,�f-s-l-�----------- ----- ---------- ..Jumber of living units:. __/_Number of bedrooms-. Garbage Grinde/4/e.G--_Lot Size J��C............ . Vater Supply: Public System and name._ . -------- -- ........ . ....... ------------------------ ---------------Private 'horacter of soil to a depth of 3 feet: Sand ❑ Si ❑ E] E] E]t Clay Peat ❑ Sandy Loam Clay Loam Hardpan ❑ Adobe El Material....... .._If yes,type------- ------_---------------- Plot _-- __.__-----_.Plot plan, showing size of lot, location of system in relation to.wells, buildings, etc. must be placed on reverse side.] VIEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) 'ACKAGE TREATMENT SEPTIC A [ Size. l -------- ....__Liquid Depth-_. CaPaciY /�C�.--..Ty �. CN�-Akatevial------------- _-No. Compartments_._....... Distance to nearest: Well........ Foundation------__..-----------.-. Prop. Line_.-.---- _mac EACHING LINE [ ) Na. of Lines...... `.. Lengt Qf each line..- ..��- -_-_-_-____-_..Total Length _G. -_--.._ 'D' Box...F ......Type Filter Materi`� _-/'C•d<Depth Filter Material._ � ----.__.-__-_.---_____------- ------- ___... Distance to nearest: Well..! ,.Foundation_._1_.Q...-------------__Property Line___-� iEEPAGE PIT [ ] Depth_ --------- __Diameter------ --- Number--_._.-------- __-------- ------ Rock Filled Yes L❑ No Water Table Depth ------ ------- ------ ----- _.Rock Size.--------- --- ----------- ------------- --- Distance to nearest: Well. ---------- - _ ____Foundation____________ -------- --- Line--- ------------ rr�..,, !EPAIR/ADDITION (Prev. Sanitation Permit#-__-.-____- _._-.-...-..._____ --.._-_-__.Date__.___-_____-__. ...__-___.___.__-) eptic Tank (Specify Requirements)--- _........................ .....- ---------- --I— ------------ -.--._- )isposal Field (Specify Requirements)--- • ------- ------------- ---------- --------------- - --- --------- -- ----- --- ...... ---- ---- --------- ------ ----- ------------_-- I- --------- -- - - ------- - - ------- 1-------------.--------------- -------- .............------- --- ---._.._.----------- - ------.._..- .------------ --- -- (Draw existing and required 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 )rdinances, State laws, and Rules and Regulations of:the San Joaquin Local Health District, Home owner or licensed agents ignature 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 ecome su ' ct t kman' Compensation; laws of California." ._Owner — 'Y•---------- ---- - -- ----------•---------- Title_.. (If other than owner) FOR DEPA MENT USE ONLY %PPLICATION ACCEPTED BY__ .-- `__. -_.._- - - ✓._ DATE _J��-_. . `� L� - !C1 ------ ---- ------------ 7 - DIVISION OF LAND NUMBER ---..-----------.------_. ---------------------DATE_...---------------------------- \DDITIONAL COMMENTS-------------- ---- - --- ------..------------ ---- -------------------------------------------------------------------....---------------------- ----------- ------------------------------ ---------- ----- ------- --••----- ----------------- ------- ------- --- ----- ------ ---- ---------------_----..---------- -- ------------------------------------ -- ------ -------------.._..-------_ -- - -------- ------ _ - --------- -------•--- -------------- ---------. .--- -- --------------- -----_---- --•----------------- ----•-- ------- -- - ------ -----------------------------------------•- ----- ----- _.-- -- ---------- --- —final Inspection bY:------- -- ..--.. Date '- - - :