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r� FOR OFFICE USE: FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ---------- --------------------------------- ------- ,I r o. - 3-- (Complete in Triplicate} Permit N --------------------------------------------_ i GG I • --------------------- ------ --------------- L--- This Permit Expires 1 Year From Date Issued Date lssued.:s_�----a-- ,i. 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: µ T DX ."-_.------ .CENSUS TRACT. JOB ADDRESS/LOCATIO - = �/ -- --------- Owner's Name ah �' - -'° hone . . -- P � _ Y-6 Address------------------------ - : `-{ `" l' 'g -------- --------- .City_.. Zip ,�,- _ J Contractor's Name------------ - r V License #_ Phane__7 Installation will.serve: Residence Apartment House.[] Commercial ❑ Trailer Court ❑ Number of tel ❑ Otthher---- ------ ------------- ----" ---- i living units:____- I_..-__ __Number of bedrooms_.__A/...Garba a Grinder Size.-.�g_____. ___2 -7 J -- - i g { PP P u ly. Public System and name = __: - :- _. - -----. ----------------.Private Water S --- - - � Character of soil to a depth of 3 feet: , Sand [a 'Silt L Clay ❑ Peat ❑ Sandy Loam ❑ ;Clay Loam ❑ Hardpan E] Ado'be 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.) NEW INSTALLATION: INseptic' tank-or se' ge pit permitted if public sewer is available within 200 feet,} _5_y i PACKAGE TREATMENT ( ] SEPTI TANK � Size �'�__ -�--ry-- ----------------=-----Liquid Depth -•---- ---------- { Capacity. TYPe--� - -- --No. Compartments- - ~ -------------ci Material__..__. I� / Distance�to"nearest: Welt-----10�------'-------- -------------Foundation__'__10... ........ Prop. Line--S_;--------------- II : r r LEACHING LINE:. [ No. of Lines-----------------------------�Length of each line.------�S-- ----------Total Length.------- -------------- D' -- -- - D' Box..:..____.._ ype Filter Material--- Filter Material__s___._a�.___`____________________________________�_- 1, ,*- . w Distance,to nearest: Wei l_;___)&Q__rf__.____.Foundation___._)®_�"f'-_._:---Property Line------ .___.----__-.-. SEEPAGE PIT Depth.: 4.__.__Diameter_:__ -____Number--------- '� _______.___F rr �Roc� Filled Yes No❑ r J Water Table Depth- = = Rock Size:�7� Distance to nearesf:1Nell_ .�•�_0____.._ Foundation._.__la_ {'__--` Prop. Line__S..-_ ` -------------- REPAIR/ADDITION (Prev-. Sanit M ion Permit#----=- --' -------------------------------Date--------- ------------------------------------ SepticTank (Specify Requirements).------__- ° ------ ---------------- =-------=------------------- - ----=------------------------------------------------------------ -------- Disposal Field (Specify Requirements)------- ---- ---- -- ------------------------=------------------------- ` --- ---= -------- ---------------------------- - - -- . -- ----------- ----------------------------------------- ------------------ ------- -.----- - ------------------------------ - ---------•----------------------------------- ----'-----------------------------------------------•------=------------------ . ----------- - i " (Draw existing and required addition on reverse side) ' k hereby certify that l have prepared this application and that the work will-be-done in accordance with San Joaquin County Ordinances,, State Laws, and J�Rules and Regulations of the San Joaquin Local Health District. Home owner or licensed agents signature certifies the following. : "I certify that in the performari'ce'of the work for which this permit is issued,'l shall not employ any person in such manner as to become subject,to Workman's Compensation: laws of California." Signed =----------- I r--- -- -- ----=----= -------- -= n Ow of I --- Title --- --- ------- r A BY= ---- ------- - f other than owner) i FOR DEPARTMENT USE ONLY i APPLICATION ACCEPTED 8Y - DATE y --------------- =--- DIVISION OF LAND NUMBER - - ---------.-- DATE------------------- ----------------------- t ADDITIONALCOMMENTS---------`----------------------------------- =------- -------------------------------------------------- ---------------------------------------------------- ----- _= - `' -------.------------- ----------------------- ------------- f ° ,__----_"-------------- ___________-i.___ ____________-.------------------------------------------------------------------------ ----------------------- ____.__._ 7 _ _ __ __ __ __ __--------_------ -------------------------- x� _ ------=-----=---=- ------ --------------------------- -----D ----- --------------------------------------- --L - ate-_---------` ----�--- ---------------- °_... '. Final Inspection by:-------- -- -- � ` -- -- --------- - ------------ II i F&$f2)�j REV. 7176 3M t es+ i3 za SAN JOAQUIN LOCAL HEALTH DISTRICT