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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ----- Permit No -�-�S ;. (Complete in Triplicate) ----------------------------------------------------------- Date Issued = This Permit Expires 1 Year From Date Issued -. Application is hereby made to-the San Joaquin Local Health District,for 8,,p`eriiit to const'ruci;acid install the �ivork"..herein described. This application--is-madeAn-compliance-with:County-Ordinance No-549-and-existing Rules and iRegulatr ns: ADDRESS/LOCATION JI3Q --- --u ---------�Zo -----------.CENSUS TRACT ,------ JOB Owner's Name _ �� 19 7per'Z_�---D,� - ne - -' PAo 3 z 62 �� I O-ntcy -t1 City - .1d✓7C�4 t4; -- - Address - -- ------- r Contractor's Name --( {� /I -------- ------------------------------------ --------License # yr-gI !? Pharie j !c-"�� - Installation will serve: ResidencdFrApartment House-E] Commercial ❑Trailer Court Motel ❑Other -------------------------------------------- , � Number of 'hv ng'units:----1------ Number of bedrooms - --__Garbage Grinder ------------ Lot Size l�+ - -------------•- V 1 Water Supply: Public Syster -'h--and name -------'.'•.�-�---------------------------------------------------------•------------- I �Pr.ivate Character of soil to a depth of 3 feet: Sant g Silt:❑ Clay ❑ Peat❑ Sandy Loam -❑ Clay Loam ❑-... ^` Hardpah E] Adobe-F-1 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 epage pit permitted if public sewer is available within 200i}feet,) [ ] SEPTIC TANK. ] Size--------------�-�--�_-------------------- -liquid DeP ------ PACKAGE TREATMENT p SE T e -------------- Material--- ------No. Compartments -----._----------_---- Ca acitY ---- ------------- Yp ------__-------`r Distance to nearest: Well ------------------------------ -----Foundation ---------------------- Prop. Line ---------------------- LEACHING _---_--- ---------- LEACHING LINE [ ] No. of Lines --------------- -------- Length of each Iline -_-----------------.------ Total Length --_---------_---__..._._--- 'D' Box ----------- Type Filter Material ----------:-A,�'Aepth Filter Material -------------------------•------------------- Distance to nearest: Well ------------------------ ,.� �r [ - ------------- -Found tori -------------------- Property Line. ---------•--------•=---- SEEPAGE PIT '" Depth --------------_---_ Diameter Nurribe! J-----_------------.--.--- Rock Filled Yes E] No i--- - Table-Depth•,.------ ------------------ -Rork Size Distance�to nearest: Well --------------------------------- -- Hridation --------------- ---- Prop. Line --------------••------ f Date ----------------------------------) REPAIR/ADDITION(Prev. nitation Permit# -__._-__.--.-.--------- i + "i ) ,p x + Septic Tank (Specify Requtitern ents) --W - --- / f" ---`�-, -( J--- ,.- �1 Disposal Field (Srecify 1 J.qu+rements) OFXIVI�v{s__._-__ = - 4 I . �._ ' -------------------------------------- y-------------------------- y. a 17 JDraw existin0_and re wired additions on reverse side) I hereby certify that I have'pre ed;this application and that the work will be done in accordance with San Joaquin County Ordinances, State Laws?and Rales and 66gulations of the San Jadquin Local Health Diistr)ct. Home owner or liven- sed agents signature certifie t e4a lowing: j I.— • .� i -"I certify that in the performance of;lhekwo�k foF-Which this permit is is rued, I shall not employ any person in such manner an``s-'Compensation laws of California." as to become subject to V4lorkmj Signed - - ---- - - - '-- ------------------ ---°' _- s---------------=---- Owner I r If other than o i -___ Title - .--�___ BY -:: F - ( ------- - --------- - 4 ; ---`------------------------------- ------------------------ i i(ner) i J' i `ICOR 0EPATlY�d1'EI T USE ONLY APPLICATION ACCEPTED- --------•-----------------=-------------------------- ------------ DATE -------- 5 ` --X-14-l-t--------=--- BUILDING PERMIT ISSUED `; { •`` DATE - ----------------- - ADDITIONAL COMMENTS 1 -- f_-- '�'_.-- -- --------------------- ----------------------------------=----------•---------- F - r e �----" .. ---------------------------------- ------ A----------------- -- ----- - - - --------- ----------------------- ------- --------------------------------------------- ------------------------------ -------- --I :-- -------- - - ---- p = Final Inspectio ---- --- ---- ----------------------------------------. ate ----- `_l b ,, ------ L SAN JOAQUIN LOCAL HEALTH DISTRICT E. H: 9 T-'k? Rev..5M