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..e� FOR OFFICE USE: FOR OFFICE USE: -------------------------- APPLICATION FOR SANITATION PERMIT (Complete in Triplicate) Permit o.._.._________________ ------ Date Issued.--Ca-v2 '--- This Permit Expires 1 Year From Date..Issut d 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 existin Rules and Regulations: JOB ADDRESS/LOCA N_a??� "� _.__.____ --- `C--L�- ---- 4------CENSUS TRACT. �_1 /'� ___. Owner's Name.---...Ttm -------------------------------- ------ ------------------------Phone.-cr3s� AddressJAS-------------- ----------------- -------' City- -isC e-ti.^f0a----------------zip-----..t Contractor's Name6__75 ,__ ------- ---- --------License ---Phone_ Installation will serve: Residence ®/partment House ❑ Commercial ❑ Trailer Court ❑ _Motel-P--Q hew--------------------------------------------- Number of living units:_"..'___-__.___Number of bedrooms_. __.Garbage Grinder------------Lot Size_______ '-- ------------------------------- Water .. ...........................Water Supply: Public System and name = a` - --------------------------------------------- -------------------Private . { _";�------------------------------------ Peat of soil to a depth of 3 feet: Sand ❑ Silt E]__ Peat ❑ Sandy Loam ❑ Clay Loam ._v Loam _._.. ._ Hardpan ❑ Ad be ❑ Fill Material-_.---..-.--if yes, type.________"_-.__.____- -..-_.�_ - r (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 permitter if public sewer is a ailable within 200 feet,) PACKAGE T"REATMEN�j T _S_EPT.IC.TANYC—[Ad ize 'VS ---- - --Liquid Depth-.----�-i4--�- J ------- Capacity yTYPe � 0fi3_• �------No. Compartments Af .. Distance to neare # Wel1�_ _ ... Foundat n.--- - Prop. Line.____.---------------- _ _ _.._ Q-- ------Total Leth. LEACHING LINE [4]!No. of Lines_____ _. :^-- .Cength of each line - ____--_---.-- D' Box-f__/----Type Filter Material-, �L_'6epth Filter Material.----- ------------- =---------------------------- Distance to nearest-Mell_____ ._Foundation._ b_ ,,�_1-___ Y ProP ert UnO.:)o i SEEPAGE-PIT yy' Depth.��r----Diameter- ---._, /Nvmber....... ._ Rock Filled Yes No E]Water Table Depth'---- cS-----=----------------------------------Rock Size. .. ��'�-------------------- Distance to nearest:,Well.... ------------------ roundation.__,�&__/-_---..--.-.Prop. Line.. /--"_-_---_._ REPAIR/ADDITION (Prev. Sanitation Permit#__ ___._._t- ------------ Date--------L--------------_---._-_---.--.--.-------------------- Septic Tank (Specify Requirements) `----------------------- --------------------------------------- -------------------------------- ------------------------------------------- Disposal -- --------------------------Disposal Field-(Specify Requirements)._____._---; -------- " -� ---- �.� w� f _ _- ;, :-a r-- _ ' (Draw e ting 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 Law's and Rules and Regulations of the San Joaquin Local Health District. Home owner or licensed agents signature certifies the following: "[ 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 subjec Woikm s Compensation laws of California." tA Signed----------- ----- --------- ---i.. - - Owner �� —�� / ; ' ---Title-----------------sem/ __ �,S.,L_,. BY ------------- 1 1#:other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY --,--- _ ------DATE.------ ........ A DIVISION OF LAND NUMBER. -------- -----i V-� ---"- , ----------- --------DATE.. COMMENTS -------------- ----- -- -------------------------------------------- ----------------------------- ------------------------------------!X=---- -- -------------- ---------- ----------------------- - ---------------------------- ---------------------------- ---------------- .z r _ --------- ---- - ---------------- ----------------------------- --- -------------------------------- --------------------------------- - ---- ------------------------------- :'- --------- ---- ---------------------------- ------------------------------------- Final Inspection by:: --- --- ------- Date. = EH 13 24 SAN JOAQUIN OCAL HEALTH DISTRICT Fns 2 V. 176 3M