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FOR OFFICE USE: FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ------ Permit No....� �`� (Complete in Triplicate) �- �l .. Date Issued.....-f._ ........................... This Permit Expires 1 Year From 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/Lor TION !-V..-----. -,.... ��l�..._..._...._ ---------------CENSUS TRACT........... ----- ----- ° Owner's Name.... ��' .C7 F'_C�1....._/V.r.. _1: �__l_/.X� ----- ------ --•-----....---------•-- : ---------Phone---- Citv •-. Z'ipAddress /D. ---- --- ------- ..._.q. -... o Contractor's Name-------- ��Z�%/vl-..._...License #----•------...-•-- Phone. Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other.........._--------------------------- Number of living units:-------.`-------Number of bedrooms...__ Garbage Grinder-_..-.......Lot Size-..-.__......._ ._.__ _. _..__ � �-8y7 Water Supply: Public System and name- - ------- - ------ ---------------------------------------------._..- - -- -------------------------- Private 9 Character of soil to a depth of 3 feet: Sand ❑ Silt ❑ Clay ❑ Peat ❑ Sandy Loam ❑ Clay Loam ❑ Hardpan E] AdobeK 'Fill Material__.___.If yes, type----------------------- W (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) O NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK [y(.] Size._..I�_� -�•- ' % •----- -------- Liquid Depth..?-- . _ _--------- �/ r� Capacity_ ?Q-921-Type--CPrnCst C__...-Material •-- ---No. Compartments.----_--�-...----�-s-.�,-.--- �l�(J Distance to nearest: Well....__.6j_.�-� Foundation...._ Prop. Line._..- �.T`-/�---. LEACHING LINE 1#4 No. of Lines____.1..................Length of each line..-.. -------Total Length _IW --..-------_----- /r /4?--- -- Po --D' Box ......Type Filter Material �k De pth Filter Material.-___. Distance,to'WIXOT nearest: Well_.. .._..,...__...Foundation.___%!-/--/-f--...Property Line.....` 7.J�- SEEPAGE PIT [ ] Depth..��-_-Diameter.._ 3�----.Number--_..{----------------------- Water .-_-_--- - - -------- ----------- Rock Filled Yes (� No❑ t---- -------- ................ Size.---- Water Table Depth.----....��_��^— ------------- �- -- ----..._...--------Q--- Distance to nearest: Well.-..../;�,�/-_---1.............---••••Foundation.l.../�.��-- ---Prop. Line._.''..��--------- REPAIR/ADDITION (Prev. Sanitation Permit#-----------------•---------------= ...........Date----------------------- -----} Septic Tank (Specify Requirements).-_-_.................................. •--- Disposal Field (Specify Requirements)-----------_----- -. . _ ............................................. ---- -- --------------- ----- --------•------------ -----•--•-- ................ ........................... -------- ------- ........ ........................ .................. -----••-------------- ------- (Draw existing 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 Laws and Rules and Regulations of the San Joaquin Local Health District, Home owner or licensed agents O nces g signature certifies the following: "I certify that the performance of the work for which this permit is issued, I shall not employ any person in such manner as to bec me lett to Work s o pe a ' n.1 of California." Sign - / �✓ .1L. - Owner BY-•----------------- - Title.-- ---------- ------------- (If other than owner) FOR DEPARTMENT USE ONLY ACCEPTED BY----- J. ___ _��^ - -- ...-DATE ----- LZ--?------------- APPLICATION OF LAND NUMBER.. - - --------•-...-- DATE. - -- -------- DIVISION ADDITIONAL COMMENTS � �--_' _-_.. ..._. - ... - V 121.._.311/......Uh - -11.-Cl�r7`- ....... •-•--•... ... - ----------- - ------------------- -------- - Final Inspection b '��------- Date.....ro- -----7. ._7 EH 13 24 SAN JOAQUIN LOCAL HEALTH DISTRICT F&s scan REV. ��a aM