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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT _ --------- -- ----------,•------ -------------- Permit No. --��--�c)3� (Complete in Triplicate) t/ ---- ----------------------- This Permit Expires 7 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 PO—P- I)i----- _}-m,s---2. _7C?- -- =---679 CENSUS TRACT -Jy-7--------------- Owner's Name __ pe o7_C.et-- --Its,.-ewis'----------------------------------------------------------------------------Phone ------------------------------------ ----------------------- �p Address ---2-3-70 + F-- �' 1z l 11 '------------------------- .......... --- City .. ---- 7��--�0------------------- Contractor's Name --- __e: rr ___ r__ _ _1_e/']______________________ License #.2e.3-4?/:;Z Phone C;%2$-6 Installation will serve: Residence artment House❑ Commercial ❑Trailer Court. ;E] Motel ❑ Other ------------------ ------------------------- Number of living units;----- Number of bedrooms ___._.Garbage Grinder ___________ Lot Size -_________________________________________ Water Supply: Public System and name -------------------------------------------- _____________________ _ __ _ ------------------------------------------------Private �� . Co��-�e s Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay Z�-- Peat❑ Sandy Loam ❑ Clay Loam ❑ _ t Hardpan [dobe ❑ Fill Material ------ ----- If yes,type ---------------------------- (Piot plan, showing size of lot, location of system in relation to wells, buildings, etc: must be placed on reverse side.) �1 NEW INSTALLATION: (No septic tank or se page -pit--peMiitted'if-public sewer is available within 200 feet,) PACKAGE TREATMENT [] SEPTICTANK'f I Size______f _QQ__ -.4Z------------ Liquid Depth -K------- p Capacity -1�r�-arQ #YPe -------------------- Mcteriaf: -----Crlr�tcSNo` Compartments --�+G--------�-... Distance to nearest: Well ___ 'a _________________Foundatiio�n __�Q____________- Prop. Line LEACHING LINE [ ) No. of Lines ------ ------------- Length of/regca line-----t�.d_._- Total Length ---1-2.0........... D` Box ----I------ Type Filter Material _�( Z.-, p . __ _ Gt' e th Filter Material _____l _g_ ____________________ f�' lam, - � 0 i-.... .. Distance to nearest: Well --4-4-4 --------- Foundation ________________________ Property Line _________ _.__._.___ F !( —'e SEEPAGE PIT [ ] Depth __2.5------ Diameter _�3_____ Number ______�.____ (� �❑ Rock Filled Yes @;---No_ Water Table Depth _ _®_�_=_ Rock Size 12--------------------- Distance to nearest: Well ------- -©--------------------Foundation ------- Prop. Line -------------------- REPAIR/ADDITION(Prev. Sanitation Permit# __________________________________________ Date -------------._____-______________) Septic Tank (Specify Requirements) -- ---------------------------------------------------------------------------------------------------------- Disposal -- ----------- ---,----------------------------- Disposal Field (Specify Requirements) ----------- ------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ----------------------------- ----------------------- --- - ---------------------------------------------------------------------------------------------------------------------------------------------- (Draw existing and required'd-ddition 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 licen- sed agents signature certifies the following.- "I ollowing:"I 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 subject to Workman's Compensation laws of California." Signed ---- ---------------------------------�--------------------- Owner Title ----By ----------- fo r than ownerFOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY --.,_ ---------------------- -------- ---------------------------- DATE _�6--- 3'� ------------- -- -- - - --- = BUILDING PERMIT ISSUED -------- ------------------------------------------ -------------•---------------------------------------DATE ------------------------------------------- ADDITIONALCOMMENTS ----------------------------------------------------------------------------------------------------------------------------------=----------------- - ----- ------------ - ,�- � .fct tel` -------------------------------------------------------- ---------------------------- ' ----- ---------- ------------- - } Final Inspection by: oe Date1�` - -- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'G8 Rev. 5M