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FOR'OFFICE USE: APPLICATION FOR SANITATION PERMIT ......... _. - .................... (Complete in Triplicate) .................................................... This Permit Expires 1 Year From Date Issued FOR OFFICE USE:/ Permit No.,.-_�,1 Date Issuedl,3 .9_. 8 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 Ordinan e No. 549 and existing Rules and Regulations: ! ir- ,,ai : -..•-,-,mow" �-'" .......JOB ADDRESS/ ......... US ..---- - ... ,i . ----- Owner's � «ity.Zi CAddress49 Contract'or's' r t '�`�"' License '#151+rf Phone ._ ----- Installation will server sides a Apartment House Commercial ❑ Trailer Court ❑ j Otner•.%� ` r� 7 Number of living units:---Numbe�,of bedrooms.Q, _.G` age.Grmder..._Lot re--_. .�� �t x� v- U ...,.,.....�...•._.. - Water Supply: Public System and ndme-r......___.. -t .------ �--- -- Character of soil to a depth of 3 feet: = Sand ZJ.---1Ilt Q •,'flay ❑ r Peat E., ..r.Sa J[:y � ❑ Clay Loam •jJ1 I i ,. + Had 'an ❑ Adobe: ❑ fill aterial_. --.... If yes, type !�''9-- " ....... .-- -.-: : ,-•---- ti t Ir {Plot plan, showing size of.Jot�location of systemrin relation to' wells, buildings,lltc. must be plati n reverse side.) NEW INSTALLATION: (Nonseptic tank or seepage pit permitted if public se er isticrtllable with 200 feet,) ellfv PACKAGE TREATMENT [ ] SEPTIC TANK "' ' ` ' ' I Size __' :._ ')` �•+ ------------ --- ; �? !Liquid Depth.:--•• ---- Ca.pacityl b. - - - pe..C� J. ...Material_ :_ .No. Compartments__-.�.�-r�`........ ......------- o . ..Gi Distance.to nearest; Well.to _.._------ foundation: de a...- -_Prop.Line_ _ _ _... LEACHING LINE N of%Lines'.- ,............ ...:.fength of each line . } � Total Length . . ! _�. '_ '__ D' Box / --_#' Type Filter Material Depth Filter Material �O ----'- -- ;....... a _ -` _, i -------' - i r,- " -Distance to nearest: Well :__ 4..� :.....Foundat�o j� �� "-- .Property`Line -_ SEEPAGE PIT [ ] Depth ..... Diameter..:_. , _ Number : -. __. K� 1 _. ? Rock Filled Yes ❑ No ❑ 'Water Table Depth..- --------------= --------_.'•_.Rock Size-...- - -------------------------------- - Distance.to nearest: Well .......... -.......... I ........:...... •--•--------- -- prP op.:-_---..--.------ f ; REPAIR/ADDITION (Prev. Sanitation Permit #--------------------- ---- Date"-::: --.-•-,--.-•--.._..----------- l is Septic Tank (Specify Requirements) - -if-: .......:.......:. ----- - - - --- --- - Di.sposal Field (Specify Requireiments)---- - ....:.. .._.,....... .... .. - ---- •----......-------- :: �.". l : _.. .. __ {Draw existing and required addition on reverse side] 1 hereby certify that I have•prepared this application_and•-that-they-work-will*be done in accordance with San Joaquin Cans, Ordinances,. State Laws; and Rules and Regulations of the San:Joaquin:Local"Health District, Home owner or licensed' age signature certifies the follawing: l 4 "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 .to becomee� subject to Workman's Compensation,. laws of California." Signed../.0 l'i . y� r ' � Own _ h = (If other than owner] t FOR DEPARTMENT USE ONLY:, APPLICATION ACCEPTED`BY_:._... _...............'. .._. _._DATE.__s ..� _-•-•• DIVISION OF LAND NUMBER' _•..._.._.:............ '---. .... ..........•--....:=: DATE .................. ..._..•---- ._: ------. -- t %DDITIONAL COMMENTS.------ •-_--------------- --------------- •------------••-- ----- -------............................................ _..._.......... .......................... --........_.._............. .............................................................. ..................... ..............- .............. -------------------- - ............ --------•--•.......:....... - - - < ---•-••--------------•------------ - Final Inspection b - --:Date.....-� l PSS 21677 REV EN 13 24 SAN JOAQUIN LOCAL HEALTH DISTRICT �,v� 3M Cf1-rte'