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_ –/�� FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT �.... Permit No. ..7.................. (Complete in Triplicate) •= ----_-- .--- "V. .......... This Permit Expires f Year From Date Issued Date Issued .-37 .71/ 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: JOB ADDRESS/LOCATION ......._._._ T�o. 'Cardzna:l .................. --`_- `._- '.- -- - .. . .�-..�` CENSUS TRACT .............�,......... Owner's Name .NIr.,....Ds'ea�raoxl ..........:............... Phone ..�:o.8...2.93.'..180... ' M San Jose, Ca1ff. 95216 Address ...... _. 7?0..Nor hup.... ? .. ..__. Ci# Contractor's Name Blark al'V.s.-Se.P is--Tank----------------_.....--....__.License # ..-. g95 ..-. Phone _..463.-7o4s Instdilation will-serve:— _=Residence'-® Apartment House,E] Commercial ❑Trailer Court Motel ❑Other ............. •--- .-..-.._ Number of living units:.......... Number of bedrooms -_:........Garbage Grinder ...._.... ._ Lot Size _..... 0 'X.F00' Water Supply: Public System and name .............................. ........ ...................... --•------....---- ------Private ❑ Character of soil to a depth of 3 feet: Sand b Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay loam [] Hardpan ❑ Adobe ❑ 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: INo septic tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT f ] SEPTIC TANK-f Size................... ...................... ..... Liquid Depth ......................... Capacity ---- Type .................... Material............. ...... No. Compartments ---•--------�• , Distance to nearest:-We'll . . . ....... .. .. ......_.--.-----Foundation ............._....._ . . Prop. Line .....................� r LEACHING LINE ( No. of lines 1. ._... . .. Length of each line ..... -_.40.............. Total length ....._.....4-0..........�V 2 __-_-.--De Depth Filter MateridE1------.......... .� 'D' Box ..� Type Filter Material _......._��_ p ...____............. Distance to nearest: Well ........................ Foundation i:5!.=:'........ Property Line ----15........-----.-• SEEPAGE: PIT Depth Dion4 ter --------- Number ..11.. :,y-.__ ....... Rock Filled Yes No 90 1 �. �^ Water Table Depth ................................................Rock Size 2„_........_.__. '....... i Distance to nearest: Well ...-..---.--- .--....,,. _ ..._.'TFoundation.-,•. Q-=.. .._..x._ Prop. line .....�.0'..........� REPAIR/ADDITION IPrev. Sanitation Permit# -------..__..- Date .................... _---._-} P SepticTank [Specify Requirements) ....... .............................----------•- ----.._.....------.......--•-------._...._....-...--- ..........------------•-------•-••--/ Disposal Field (Specify Requirements) - .-----_�4 4b.'..-I.eacG ._Lilae...&...33."..X25.`...P.7.�t.......................... •--..._..- ...............----.......---------------........... . . -- i ; (Draw existing and required addition on reverse side) ' I hereby certify that I have prepared this application and that the work will be done:lei accordance with Son Joaquin County Ordinances, State laws, and Rules and Regulations of the San Joaquin local Health District. Home owner or iicen- Esed agents signature certifies the following: "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 become subject to Workman's Compensation laws of California." Signed .:.. .. •-------------- Owner ' x v r --------. Title . .._.�.. ,..` .... . ..... .........----....... BY ... + (if other than owner) 4 i FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ... DATE ......�u i5. �.. BUILDING PERMIT ISSUED ... ..... ........................... ................4...........------......-- .........-DATE ... ................................. ADDITIONAL COMMENTS ................._------------- ...................................................-- --.......-•----- ......... ---- __------ -------------------- -----------------------•--• _ ... ....-...._...--................................. ............. ----- .............. ---.................................. .-........ =----------------------- -- . -•.- -------..... -------•---- ---- ........---�. . --------- ........---- - --- ..........................._. .__� .. .�. . .---•---------- Final Inspection by: . -----.-Dote .......... ISAN JOAQUIN LOCAL HEALTH DISTRICT CP 7 1 9/. _ .._ _ -i 1-70 9 u