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FOR OFFICE USE: FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT •---':---------- "" (Complete in Triplicate) Permit No.. 9.r. 6... ...... ......... ........ t --... This Permit ExlAres 1 Year From Date Issued Date Issued- 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- .......655 0 'e-......R� _ ------------•------------ CENSUS TRACT Owner's Name --. iO.G.e'�/--,-.-.--.. ---------- -------------Phone 3 R946... .- -,. . Address � 4a� Cit /� ti fZi _---- J - #..16.6 ..--- - - -- 3 V-7Contractor's Name.. 4�7-X esti y 7c- 5;,,l V' ------------ -- ---- ---------- ---.....License #..!6- =sSG-. .Phone-------:.......---- Installation will serve; Residence 2 Apartment House ❑ Commercial ❑ Trailer Court ❑ kMotel ❑ Other--------------------- ---------------- Number of living units:..--- :-::-..-.Number of bedrooms..--3__ Garbage Grinder-------------Loi Size--- ------------ ------------------------------------------- Water Supply: Public System and name----------------------------- --- -- --- ----------•-------- -------- - --------- ------------- ----.-.Private Character of soil to a depth of 3 feet: Sand E] Silt❑ Clay E] Peat ❑. Sandy Loam [] Clay. Loam ❑ Hardpan-E] 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: (No septic tank or seepage pit permitted if public sewer is available within 200-feet,) PACKAGE TREATMENT ( ] SEPTIC TANK �.. F [ ] Size Liquid Depth. -- --...---- Capacity-- /6o01,9L.TYpe- '�..�- j.T.Material..GoH .. No. Compartments-... ---- Distance to nearest: Well. ..--.-- 5.7. ......... ..... ......Foundation__,A .--_ -.--....Prap. ------- LEACHING LINE ( ] No, of Lines ..............Length of each line....-..�d.1---------;._. Total Length .......... r 'D' Box.... Type Filter Material P'1`r '7.--- Depth Filter Materia ............. -5------------------------------ ......t Pro �v ��Distance to nearest: Well_. .3720 Foundation ypert .ie. --��.� SDepth..../ ...Da�re#er-.�.If ---------- RockFilled Y eso 'No [] . ( .��. Water Table Depth.------•----•----------------- - ------------....:----Rock Size.----- ------ ---- ---=`...:....----- -- Distance Distance to nearest: Well---.../'�r.'_fi Foundation...........�0 ...- - _ Prop; Line............-.--.. REPAIR ADDITION {Prev. Sanitation Permit#,........... ........ ----------Date ;-. ............ Septic Tank (Specify Requirements).-- ---_---------- ----------=--*"L-- _-)- ------- --------- - - ------ js Disposal Field {specify Requirements) -------- ---------------------•------------- ---- -- - --"----------------- -------•------------- .....................� --------------...-- ......... ---•------------ ----------------- ------------------------ ---------- ----- (Draw existing and required addition on reverse side) { I hereby certify that 1 havePP re ared this application and that the work will be done in accordance with San Joaquin County R P Ordinances, State Laws, and Rules and Regulations of the San J ao quirt Locai Health District. Home owner or licensed agents t. signature certifies the following: "I certify that in the performance of the work for which this permit is issued, 1I shail not employ any person in such manner as to become subject to Workman's Compensation laws of California." Sig ned .:.A! T/So { -Sgt' Owner _ ---------------------------- BY--------=- .............Title.................. . - - her than owner) t R DEPARTMENT USE ONLY v APPLICATION ACCEPTED BY . .......... :.. .. :.:...:..... ---.-......--....._.. DATE DIVISION OF LAND NUMBER �. ...... ................ ---------....-.--- ADDITIONAL COMMENTS-------------------- -< .._DATA.-.. = "._.._...... - ---------.. .. --..... . '`---------------------------- -----._.-. ...... .. ------------ -------------------------- - --------_ ----------------------- .. �a ----- i ------- --------- - ---------- -----------._.......... .....�..--- Final Inspection by: ....".!` -- -- -- -- Date. EN 13 24 SAN JOAO LOCAL HEALTH DISTRICT fey_22W7 REV. 7/76 3M s