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�'''----- FOR OFFICE"USE: � =•- �= APPLICATION FOR SANITATION PERMIT (Complete in Triplicate) Permit No. ---- -_------ ---------------------------------------------------------- This Permit Expires i Year From Date ls4d Date Issued ------------------- Application is hereby made to the San Joaquin Local Health District for a #m p it to construct and install the work herein described. This application is made in compliance with County Ordinance Wo. 549 and existing Rules and Regulations: U JOB ADDRESS/LOCATION .-_. "7- - i .----[�t�....Fi_,_POr ---- ^" ---------------CENSUS TRACT Owner's Name _ -V_fT?.-' Phone - ---------------- --- - - - -- - - -:�.----�--- Al d 1 �j p ,� p ^ City ✓ 1 PQ Y4� ---`------------ -------------------------- Address --------- ------- 1[V------- I-r-&N------�.Y.-_. -- Contractor's Name .- I t rtjLj , �--------------------------------------------------- License # ----- -------- ------ Phone-- - ----------- -�-...---- Installation will serve: Ra'sidence Apartment House- Commercibi # ❑ p ❑ ! ^�Ttailer Cnru1 !,�� 1� - Motel ❑ Other Number of-living units:---- Number of bedrooms _L__-Garbage Grilder /Y - Lot Size ------------- Water Supply: Public System and name -----_----_- — Private 94/ Character of soil to a depth of 3 feet: Sand'❑ Silt Loam,[-] ❑ S ndy Loam .. :. Clay"Loam ❑ Hardpan ❑ Adobe ❑ Fill aterial Q_2If yes, type _- -.---- Nk (Plot plan, shoOving size of lot, location of system in relation't- wells, building'', etc mus be placed on reverse side.) NEW INSTALLATION: {No septic tank or seepage pit permittediiif ublic sewer is available within 200 feet,) I' �/ �(�+ PACKAGE TREATMENT [ ] SEPTIC TANK Siz X � _ A �Q r Liquid Depth o. Capacity��r --,-- Typet E ,��yyyaterial _ ---- a. Compartments "Distance to nearest: Well _ -_--" ' "-_-_----_- oundat�an td----f'- ---_ Pro Line -_ - _ LEACHING LINE No. of Lines ----��------___-- Length of Ach line ---cg _ -.----- Total Len th..,� p---_---___-. D' BoxrE_S Type Filter aterial Rd GK-_ epth Filter Material ------t y 6' tt -----------•------------- Distance to nearest: Well --- ----------------- oundatibn - ------------ ----------- Property Line ---------- ------------- SEEPAGE PIT [ ] Depth -------------------- Diameter -------------- -- Number _--_____, ---------- Rock Filled Yes ❑ No 0 Water Table Depth ------------ ----------------- ------------Rock Size Distance to nearest: Well ----.11----------------- - ------------Foundation -------------------- Prop. kine -------------- REPAIR/ADDITION(Prev.-Sanitation Permit=# _--_--------- _-.__- ---------�-�--------- _ Date --_- ----------------------------) Septic Tank (Specify Requirements) -------- ------ -------ttct__---------- Disposal Field (Specify Requirements) -------- ------- --------•---- --------------------------------------------- ------------------------------ -------------------------------------------------- - _ _ _ f — (Draw existing and -- aired , ,:- -- --`"� � �_--_-�,- ---------------------------- g q addition on reverse side) I hereby certify that I have prepared this application and that It�he 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 licen- sed agents signature certifies the following: "1 certify t t in the perf, once f the work for which this perrhit is issued, I shall not employ any person in such manner as to bec subject to rk 's Comp cation laws of California." Sign ' - ------- - � Owner BY --------------------- --------- Title ----- - ----- (if other than owner) -------- ------------------------"- FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY -------- * j ,:C -------------------------------------- -- �_ 9 r - DATEBUILDING PER1T"ISSUE3 ) ADDITIONAL COMMENTS ---__- - ___ - ! __--- - =------- ------------------- . ----- - ------------- -- -- i' - - -------------------- - ------ - -- - - ------------------------------------------------- - --- Final I tion -� --- - -- ---------- - -----..Date .......... ------ - SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1- 68 Rev, 5M