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FOR 01 ICE USE: r APPLICATION FOR SANITATION PERMIT --- ` ---- ------ ---------- ------•---- - - Permit No, . / (Complete in Triplicate) / I--------- ---- --- ------------- � I This Permit Expires 1 Year From Date Issued Date Issued Application is hereby made to the San Joaquin Local Health District for a per 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 . z� r ��--------------(..�_-------- �1 �.---------- --- - -- `.........CENSUS TRACT -. ` +►51 ----------- Lovesv E��r R Owner's Name ��- �---- �; -------..Phone ------ ---------------•---•--------- --- ----t_-:-------��_�----- ----------- ------ --. Cit ,�1...f9QT V•---r--------------------------------•------ Address --------- z Y �-- Contractor's Name - Q -.D YS - S74F Tu- ---$_EA4J_C�__.License # ------_-.-:------- ------ Phone Phone _---------------------------- It I Installation will serve: Residence E] Apartment House Commercial ❑Trailet�orirt l[?}� Motel ❑ Other ------------------------------------ ' Number of living units:-_-- ----- Number of bedrooms _7 -----Garba_ge Grinder Lot size - ---------- Water Supply: Public System and name ------------ ------ -- -1 ' - ......Private �� r- I Character of soil to a depth of 3 feet: Sand' { Silt❑ Clay E] Peat E] SondyiCoam �] Hardpan-E] Clay Loom El ��R� COvRS � Adobe•❑ FillMaterial If.yes,type---''---..------=------_- (Plot plan, showing size bf lot;-location of system in ro.lation torwells, buildings, etc: must be placed on reverse side.) NEW INSTALLATION: (No septic tank~off or it permitted if ublic sewer is available within 200 feet,) Z1 d PACKAGE TREATMENT SEPTIC TANK Size--- 'xo_-x-- __--_--.1- ------- Liquid Depth __. ._.--------- r Capacity /Z'00- - _-__ _ ype . p TC - Material-CD _E No. Compartments �4:.... � �istance-to nearest: Well ------ ___"� ----------Foundation -.�1�_--=-- --_ Prop. Line ---S--_-'�----- LEACHING LINE [/J' No. of Lines ----_ ----_-.- gth of each line_._- -�.----`------ Tot6l Length :__1eo___�--_-.. Len i i +�C I /q rr i D' Box __ 5 Type Filter Material' -:.'_ ptli'_Filter�Materia�-----<-/ -------------------------------- _. .De. } Distance to nearest: Well _--- - __" - Foundation -------=Property Line. i SEEPAGE PIT [ ] Depth -------------------- Diameter - ---- .. _ Number -------------- L-------- :Rdck Filled Yes ❑ No ❑ j j� -- '--_------- Water Table Depth -_� Rock Size ------� -------- --------------- Distance to nearest: Well ------------ ---- Foundation -- a._--.-_-_---.-- Prop. Line ----------------- ----------------------- y REPAIR./ADDITION(Prev. Sanitation Permit# _---_- ------ ---- ---n?iA ------- Date ____-_--____._'•--_-_---�---_----) k i Septic Tank (Specify Requirements) ------------------- ----- t ! - -- - - _----- ------------------------------ Disposal -- Field (Specify Requirements) ___--_-_- _- I l - �T� 1- ................................... -- � ." r(Draw existing and required ad'dition_on reverse_slde),,+ r � ^`(•,7 I hereby certify tha31 have prdpared this application and that the work will be done 'in accordance with Son Joaquin. - County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health 'District. Home owner or-licen- sed r_licen- sed agents signature certifies the following: } "I certif performance the work for which this permit is issued, l shall no employ any person in such manner as to beco c s bject to Work s Compens tion laws of California. If Signed ----- - ------ ............. ----- . . --a "y--- n�_ Owner (f BY --------- J` ✓ Title . (If other than owner) L" I FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY -_-.-= )-0_!-----------------------------------------------------------------------. DATE ---- 8--- 1------------- BUILDING PERMIT ISSUED ----------- ------------------------------------------ ------------- ----------------------------DATE ------------------------------------------- ADDITIONALCOMMENTS ----- --- -- - --------------------------------------- ---------------- -------------------------------------- ------------- --------------------------- ------------------------ -------------------------- - ------- -- ------------------ --- • . W ----.-,-- ---------- ------------------- --------------- - ----------- ---------------------- --------- --------- ---------- ------------ - - - --- - - -- - Final4lnspec-tio _ - - - -_ - _ -. - •-- — - -- -- --- --------•------------------Date--- - - SAN JOAQUIN LOCAL HEALTH DISTRICT 4 . E. H. 9 1-'68 Rev. 5M