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FOR OFFICE USE: APPLICATION FO Ri SANITATION PERMIT ^ - --------------- ------------------ N , Permit No. _.7/�5�3 –QGomplete-in 7°riplicat.el ��"• ---------=------- --- ---------------------------------- Ci -. i. Ve—r s .,� -Date Issued: --------_---- --------------- Application __ This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Health District for a per to construct and install the work herein i described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATi --------------------------CENSUS TRACT ? Owner's Name re s_I ------••----------------------------- Phone.- s �� 1�' f Address _. �,3 - a .. �----- --- City f /mr�l = Contractor's Name .5----------------License #ld;tV+I/-------- Phone �- ------"'-g�� -- _._—Installation.wilI serve:........,..,,,,,,,„....Residence _ _ApaRr ii nt,House,![]•Comm-ercial ❑Trailer Court_i❑____�. I Motel ❑Other ------------------------- ------------------ /f ` Number of living units: ----- Number of bedrooms -_. -_--_Garbage Grinder ------------ Lot Size --------------------- ------------- Water Supply: Public System and name ---------------------------------------------------------------------•---------------------------------------Private❑ r Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay E] Peat F] Sandy Loam ❑ Clay Loam Hardpan ❑ Adobe�Fill Material _.-- If yes, type ---------------------------- r ,. { (Plot plan, showing size of lot, location of system in relation -to welds;buildings�efc.,must be placed on reverse 'side.) NEW INSTALLATION: (No septic tank or seepage pit permitt�f public`sewer is available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK'[ ] .��Size-----------------------------------•------------ Liquid Depth ------- F-------.----- ..�� Capacity --------- -- ------ Type - ---- Material----------=-----------_t 4o. Compartments -- ----------`--------- i Distance to nearest: Well ------------------------------------Foundation ---------------------- Prop. Line -- ----)-_-- -------- f � LEACHING LINE ] No. of Lines ------------------------ Length of each line--------------------- Total Length -------- -_--- 'D' Box ------------ Type Filter Material --------------------Depth Filter Material ---------------------------- Distance ---.----------------------Distance to nearest: Well _---_ -._. .----_____�Foundat.ion .____.._.-�. ------- Property Line ---- .,._ i' i SEEPAGE PIT [ Depth .------ ------ Diamete ---------------- Number --------.---__I--------_ Rock Filled Yes�� No �. Water Table Depth --------------- ------------------------ -------Rock Size --- � F Distance to nearest: Well ------- --------------------------------Foundation ----------------_--Prop. Line _.. .......... E REPAIR/ADDITION(Prev. Sanitation Permit# -------------- ----------------------------- Date ------------- ---------------- ---1 t� -------r---_-- f:Se tic Tank (Specify Requirements) ----------- � - € . ��-/--�--- . ' = --c,_ �Di� sal Field (Specify Requirements - ------------Gf.�a ) , ..t�t_4-. ------------- ---------------------------------------------------- Draw existingand required addition'on reverse side) w ' I herl by certify that I have prepared this"application and that the wch,will be dine in accordance with San Joaquin pA �� y � a �; � r• � � � County,,Ordsnances, State1Laws,rand-Rules and Regulations of the San aaquin Local Health District. Home+ownerjor licen- sed a e "tsasi nature certifies tfollowin 1. l ergf itliatt in the performance of the work for r wkiCh this permit is issued, I shall not employ any person in-such manner - t a to`b cor'ne subject to Work ads o cation la4s of California." i Signed _"_______•- – -------------- - - --- - ----- Owner .� --- ---- - ----------------------------- Title --- -. � - yi (If other than owner i FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY - ------------ ------------------------------------- DATE e i.7f ------------- BUILDING PERMIT ISSUED -------------------- ------------------------------------�f._0 ------------------------°--------------DATE . y � l ADDITIONAL COMMENTS --------------- ----------------------------------------- ----- - ---------ft --------------- -------------------------------------------- --------- ------- --------- ----------- --------------------------------<)� ------ --t------ ------- ---- --------------------- ------------------------------------------------------- ----------------------_---------------------------------------------------- - t I --------------------- -- --------------- --- - ------------------------ - Final Inspection bY- -- ---------------------------------------' or ...Date --------------------' ---- -SAN JOAQUiN--L.OGAL:HEAL-TFT--.DISTRICT 3 � t E. H. 9 T-'68 Rev. 5M - #