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FOR OFFICE USE: h . . RFFICE USE: APPLICATION FOR SANITATION PERMIT --------------------------------------- (Complete in Triplicate) of --------- This Permit Expires l Year From Date Issued ------------------- "ruct and install the application is hereby made to the San Joaquin LalOrdananbisNo#549 anfor a d existing Rulrmit to es and Regulations: Work herein describedll! iris application is made incompliance with County TRACT........------------ _--CENSUS F i ,r -�.. ------... ..- _ONS r iOB ADDRESS/LOCATION...------. phone owner s Name ---------- �� G--s�- .�� 7 y� j .� �— ,� � �.rl�r - t` �`'- Zip %ddress.-- --- ... ... l' - City Is�w6 hone-_ �,��-�_�? - -- ------ Contractor's Name..._.... -_ - Commsercial # Trailer Court ❑ ` 2 i ❑ ` nstallation will serve: Residence Apartment House.❑ . Motel ❑ .. Other---- ----------------- ------- ----------- a Vumber of living units:......------.Number of bedrooms...3--;Garbage Grinder --- ------- Size-------- --- p 74E22 , ' JVater Supply: Public System and name lc;ee ---------------- --------------------------------------------------------Pnvate Character of soil to a depth of 3 feet: Sand Silt_❑ Clay❑-.. Peat❑ ` Sandy Loam ❑ Clay Loam ❑ Hardpan ❑ Adobe ❑ Fill Material- If Yes,type---------- ------- --------- --- ;Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) ! ' seepage p p r,is available within 200 feet,) NEW INSTALLATION: (No septic:tank or see a e it Size tted public sewe - Liquid Depth �--=4-= �� ------------ PACKAGE TREATMENT [ l SEPTIC TANK [ ] -N Capacity-�------ - Yp - ��--No. Com artments_-..-_---- -�-�� l---� -------------- ��_. T e.- Material.�O /Q Prop. Line. - r- Distance to nearest: Well.......... Foundation ------------ Length ----------- r Length of each line.------ -------- ------Total Le gth ...:--- 1�.----- LEACHING LINE ( ] No, of Lines-------- --------------- g �/ !J� D' Box---- Filter Material - .-t'!L3epth Filte��terial-:-- -Property Line.-....�� -�----- - Distance to nearest: Well---/Z1_1 Foundation-------- I I Rock Filled Yes ❑ No ❑IE SEEPAGE PIT [ ] Depth------------- --Diameter---------�J--..Number------ ------ -------- � ------------------- Water Table Dep#h----------------- -------- ---- - ------------- ------.Rock Size.---------------- --------- Distance to nearest: Well._ ........ .._ ..--------- Foundation ... --. - ---..Prop. Line. =£ - -_ -... ---- - - ., REPAIR/ADDITION (Prev. Sanitation Permit#.------------------- --------------------- -- -----Date-- ....... ------ --------- --------- -) �I - - ------------ -- - ------------------- -- Septic Tank (Specify Requirements)---- ----- ----------------------------------------- ------ - --------- i 1' s) . ........... .-. ---- - - - ------- -------------------------------- --------- ------ -------------- Disposal Field (Specify Requirement := 1 i ---------------- ---------------- ------------------- ---- -- -------- --------- --------- -- - ---- ` ------•--------------------- County {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 lations of the San Joaquin Local Health District. Home owner or licensed age Ordinances, State Laws, and Rules and Regulnts signature certifies the following: "1 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." j�" -------Owner Signed----- - ------Title. . Y(if other than owner) ' FOR DEPARTMENT USE ONLY �7 k DATE -f - -------}------ --------------------------------APPLICATION ACCEPTED BY - -------DATE- ------ ------- - --------------------------- DIVISION ------ -------- --------- DIVISION OF LAND NUMBER ---------- -------- ----------------------------- ----- --------------- ADDITIONAL COMMENTS---------- -------- - ------------- - ------------ ------- --------------------------------•-------•------------------------ --- ------ ------ - - .---- ----•---- - ---- , _ / . Date..-- -------.��/ `� �`� Final Inspection by.. --lam . -- --- --- ---- ---- --- r&5 i5 REV. 7'� ------------------ /76 3M EH 13 24 SAN JOAQUIN LOCAL HEALTH DISTRICT