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FOR OFFICE USE: ,J FOR OFFICE USE,: r APPLICATION FOR SANITATION PERMIT # --------------------- -------- ----- Permit [Complete in Triplicate) ' Date Issued./,P_-349:244r This Permit Expires 1 Year from Date Issued Application is hereby made to.the San Joaquin Local Health Zistrict for-a:permit.to construct and.-install the work herein described. This applicotion is made in compliance with Count Ordinanc IV o . 549 and existing Rules and Regulations: � CENSUS TRACT------•-------- ---- --- ... JOB ADDRESS/LOCATION. ....... - - ---------------- - -- -------- - .. Owner's Name. . ----------- -------------- ------ =.. Phone- ------- Address. --�.r�. -f_.0 -- --- � -----�--- ...---CitY-----.- - .------- -------- - ......... ..Zip.-._..-..^.-- •--- ---------- Iy� License #.5. 0. L-{/- ...Phone.- Contractor's Name____ Installation will serve: Residence Apartment Mouse ❑ Commercial E] Trailer Court El Mtel ❑ Other-....._..--- ---- --------------- ----- Number of living units:...../--------Number of bedrooms...3.._..Garbage Grinder_..----.....Lot Size_.-��`� - Water Supply: Public System and nom'e._-._..:.__. ' _ Private C] Character of soil to a depth of 3 feet: Sand ❑ Silt ❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam" HardIan ❑ Adobe ❑ Fill Material _ ...: -...If'Yes, type-------------- LA (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.] NEW INSTALLATION: (No ;septic tank or seepage pit permitted if public sewer is available within 200 feet,] i PACKAGE TREATMENT ( ] ;SEPTIC TANK ( ] T X -�.- // Liquid Depth.--�--.---------" Size --i- L� -{-r�------------ --- ----- q Capdcit T e--- -- - .-.'--s..:. Material.. - -. - - No. Compartments..-...- -- ----- L _.....-. v-I-- v°�.QQ---- Yp S Foundation.. Prop. Line- fie' __-----•---1 Distance to nearest: Well- --_ �d' " LEACHING LINE [ } No, of Lines . . _- Total Length .. . 7 --.__.... ....... 1 .R--------- ----- Length of each line.. _. -- -- - ?9 �_._ 'D' Box- -- /..;.Type Filter Material...._ _ Depth Filter Material_..... - -- -• .,:." -�__.. �A ..-- ---Property Line_..-_�-- -------- -------------- Distance to nearest: Weil_'" -- -,---.Foundation_-.-._��------" ry, _---- --- Rock Filled Yes No ❑ SEEPAGE PIT ( ] De pt h__...��Y....Diameter....-r/` -"----Number..--... _ t Water Table Depth.----•------ - ----------------- .Rock Size.. _,..../ ] Distance to nearest: Well... ---.Foundation------------------ ------Prop. Line ....... ............. REPAIR/ADDITION (Prev. Sanitation Permit,#----------------- --- -"--•--Date-_---------- ..------ } Aw 3 Septic Tank (Specify Requirements)..... . "_ - - Disposal Field (Specify Requirements]...-_ 1 � -- ------------ ---------------- _ ----- ---------------------•-•-----------------_.-...----------- -----•--------._....- --...._.-..... .. } l (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 County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner or licensed agents signature certifies the following: "I certify that in the performance of the work for which1his permit is issued, I shall not employ any person in such manner as to become subject to Workman's Compensation laws of California." ` i --- Owner' Signed --F. .---- � R_ ..... ...... .... ... Title ----- -_ ...... if of er than` owner FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED 13Y----- - -' � ---.-._, -.:--.-.__-••.::---�,->>.��:._��.--_�.---:-.---.::.-:.��x>. DAT.Er ........I DIVISION OF LAND NUMBER... ... . ................. --- --------- DATE..... '"..._ ADDITIONAL COMMENTS_....... --- --- --------------------------.._. --- : -------------- e ----- --- ---.. - ... ... ...................... _ ------- ------ ( _ Date. -.�� . Final .Inspection by' - - ... ------------------• --- ------- --- ------- -- ------ F&S 24677 R3M EH 13 24 SAN JOAQUIN LOCAL HEALTH DISTRICT l�-