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FOR OFFICE USE: FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT _ - i Permit No.- ........... -- ---------------" (Complete in Triplicate) t/�C- 7 Date Issued-- ---------------------------- ------------------ This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin untalOrdintanccesNo, 549 and trict for 0 rexist ng Rules and Regulations- mit to construct and install the This described. I� This application is made in compliance#fih Ca y _ 4.r_ 1 E SUS TRACT - - -- - "" r _ - _------ JOB ADDRE55/LOCATION--_" - Phone.-- ------.- -- ---------------------------- Owner's Name. ----- -----z s -"----"- ....._..�. _ zip City Fee /1/1.4r..c ..'__._ _ i Address---- "-- =."" - r License # ?_ ----- Phone-1 !�' v��Q- f - _________ _____ Contractor's Name--------------- r u }. ".,.. Trailer Co rt rt: ❑ Residence c�; Apaent House❑ Commercial ❑ Installation:will.serve: _ ------------- M -_.___.._ INotel•❑ Ofiher___ = c.- --e�BiL� .. ------ ----- u ----4 Number of living units:._;___-_C__.___Number of bedrooms:_.__S___Garbage.Grinder_ _____Lot Size_- .-'off-'-'- ----- +� ------------------ -- = ----.----: Private Water Supply. Public System and name-___-_"-.--'-------------- . :• - _ Peat ❑ Sandy Loam ❑ Clay Loam Character of soil to a depth of 3 feet: Sand El -Silt❑ Clay E] _ _If es,type----- -". -- --- t Hardpans- Adobe Fill Ma#eria.l._ _; _ . y show size of lot, location of system in relation to wells, buildings, etc. must be.placed on reverse side.) (Plot plan, s 9 ` a r � � r NEW INSTALLATION:" (1\16'septic tank dor seepage pit per i�public�sewer is available'w`thn q0Yi' feet,) SEPTIC TANKth Size--- . PACKAGE TREATMENT [ ] _} ��td Material=_- - No Compartments. ------�------------------- i Capacitypt1J*>_-:= Type= r r Foundation_�7Q- rop. L;nef - t = I ...'Distance_to nearest: Well--_ --- ---1 - �� . (� r Total Length ' th" lS 4' 1 t _ Len th of,each-line -" ---" - - LEACHING LINE' No. of Lines.:--- J _ ; :. g ] / t i/ -1��.----Depth Filfer Material_-,-----/-• . 'D' Box = TYRe Filter Material_! " r 0 �^� Pro ert k Line -. -- ' - .Foundation f p Y - �*. I ' Distances>to earest: Well- Na ❑ s r. i Rock Filled ~f`es�'} Depth _"�L$ Diameter_. YjR-- ----.Number... ` I SEEPAGE PIT t. c 1z _ �. r •,f- Water Table Depth.- :-- Foundation�._-_� T , f i 1 tine _" . _i-- -.drop. f _ : 1 f Barest: WeIL -- ' . _Distance to, € �• --._�-- ------} � , i " - Date ------- ----------------------------- Permit ,- - REPAIR/ADD;ITION_(P..rev. Sanitation #-"--== -- -------- -------------- = ---------------- - - ,,S.p is Tank (Specify-Requirements)---- - = 1 t � Disp sal Field (Spec' y Requirements) --- -- - -- -- ------- , �. _. t f i - - -" - - a - r'se side �J � ------------ - - �- I ( {Draw existing and iequired � ddltlon on rev i ` 'application and that'the work will be d'oneFiri ;aScordance with San Joaquin Co 1 hereby certify that I have prepared this'app Ordinances, State. Laws, and Rules and Regulations of:the San Joaquin Local Health District, Home owner or license agents signature certifies the following: r _ - -�. : , person in such manner as "I certiffy!.tlid#in the performance of:fhe work for which this permit �s issued, I shall not employ any � to betome subject to Workman's, Compensation laws of California." fi i - Owner --- ---- ----- , . - signed---: ---- - -"" - -- "--- - _ - E11- . -_-- --- ..- --------------- - ------ ----- --------- Title (if other than owner) i = -FOR DEPARTMENT USE ONLY ' t DATE. ` --------- "- 4 -------- APPLICATION ACCEPTED-BY------ _ DATE..---:---" -----------"--- ' .: . DIVISION OF LAND NUMBER -- -- " ----- . . •• --------------- - -- ----" -" ADDITIONAL COMMENTS-- ----------------------'-- ----------------------------- � - --- ----- ------------- ------------------- --- -- -- - ------------------ ----- -----------------•------.- • Date. --- 6 3N Final Inspection'b g -=-�- -- Rev.7/7 >:s,s 21 EH 13 24 1 SAN AQUIN LOCAL HEALTH DISTRICT