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FOR OFFICE USE: FOR.OFFICE USE: _ nom:°. �;; APPLICATION FOR SANITATION PERMIT ,; . -------------------------- - --------- -------------- Permit .. +- • . .- (Complete in Triplicate) ----------= -------- ------ - ------------------------ ` ` Date ----- __ ------ 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 Rules and-Regulations: O»JOB ADDKESS/LOCATI . -J `- . " `""= .. CENSUS TRACG�T--�---S-- �-T- ---- 'Owners'Name------- ------- ----- ---------- ----------------------- Phone- - _ . Address -- - - - "_.'- i 1-D e2rd S ------ - City �iP --- License #---------21-S> -.--Phone... Contractors Name ------------ 1 ! �� G� -- -- _- - -- - f Installation wilks e:'"<� Residence 5 Apartment House.❑ Commercial 0 Trailer Court ❑ Number of linin units:-__-.! •N u' Motel ❑ O�her -=--'-- -"__-. -' ----=-----'--:--:-- g _----- mber,.of bedroom Gnnde�r_----.-.--:-_Lot..Size-, l�--S_____r `r� ,e ; ------------------- Water Supply.. Public System and name:..- . f- ----------------- -'-.-C 'fit-._..'_-------------------------------------- Private i❑ Character of soil to a depth of 3 feet. Sand`j -'Silt❑ Clay ❑ ' Peat ❑ Sandy Loam ❑ .Clay Loam ❑ a f Hardpan ❑ Ad"obe,� Fill Material--.-- If yes, type-------------------------------- [Plot1,plan;�showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.] NEW INSTALLATIONS (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ ] \SEP.TIC TANK "[jd Siz&-i--i-_ -A Zoo------------------------------------Liquid Depth _- ---------------....... 'mss""'` Capac-sty :_:_ ,, TYPe -1 , =Distance to nearest Well :Foundation.. _._.Prop. Line.-..-!- LEACHING-LINE' [ j No-of-Lines-- len each Total L'"ength.___-____.------- , 'D' Box_.:_.. -.. Type Filter Material.__ Depth Filter Material y ___.-__ -------- I - Distance to nearest: Wel l- -----_ .----_..___.Foundation.__:.__----- -------..Property Line---------------=-------------- -.- SEEPAGE PIT,' [ ] Depth r .__._ Diameter �.-_Number___ ._____`_______ ; Rock Filled . Yes❑ No E] ' Water Table Depth.- ' k = __...__...Rock Size = !' "Distance,to nearest: Well t :____:Foundation:_ .-_ '_.Prop, Line '. -'_�• REPAIR/ADDITION {Prey: Sanitation Permit#-_- ------=------ __.Date --------_-;_-- --.--------.------------_-_-. Septic Tank {Specify Requirementsl__- 7 � •._.___f -'- "___!' __ - lYt/____:_ ___________________________________ Disposal Field (Specify'Requirements)----:--�- -��-� - ^ - -._ t - --=---------- --- - - ---------- -- -�-- -- ---- --- --------------- ----- (Dra existi g and required"addition on reverse side) I hereby certify that ml 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 them San Joaquin Local Health District, Home owner or licensed agents ` signature certifies the following: ' "I certify that in the performance of the work-for which this periiiit is issued, .I shall'not employ any person in .such manner as S! ned_____ Compensation laws..of_California.',' ,: ; I , to ecome�su ect to �/.F " an s ` gl h{ = 1 _Owner BymY E Of other than owner) I OR D PARTMENT USE ONLY'" APPLICATION ACCEPTED BY-,- -DATE. r ' DIVISION OF LAND NUMBER.:.:----- ---=�---..> -----=------'-------•--- --- - -----�=-=--=-==--�----'--=- -_ .__.,---�----------- ' � �O. ?$ b DATE. [ ADDITIONAL COMMENTS.-.-.'-..-.........--....= =----------- ------ - = a Final Inspection by.._ -•---m--- = ill, _"= = J'- = -"" = Date 3 �1 - -- '--- EH 13 24 SAN JOAQUIN LOCAL HEALTH DISTRICT F&s 21677 Rr+; 6 3M