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FOR OFFICE USE: FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT - ------ ----- �� rZ . r - (Compl*te in fii-iplicate) Permit No. __ _._____ Date Issued_.-_)_.*, _-__r7 47 -------------------------------------------------- This Permit Expires I 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/LOCATION...7./_.___._ le�..L _ -_ .. ------ � .I -P...�' . r...._..-.CENSUS TRACT..-. ` ./-. 4._. . ft Owner's Name-- X18-a----- i-+-------- ------- ---------- - ------- �,�"" _ --------Phone - Address-----aP-1_Qa---- t d? city--- """p'��'G ------- ----- --Zip-1503-3 �f Contractor's Name___ 2? _:_r _fi_l� d-A_ __._ .___.License #_iR-.,' _ Phone__ J �-_Y_ - _. Installation will serve: Residence Rf*� Apartment House❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other---- ---- --------- - ---- - ------------- Number of living units:-------/__-.__Number of bedrooms-_--.7---Garbage Grinder_-__/-___Lot Size.___. a____ - __.' d$`____________________________ Water Supply: Public System and name-------------------------- - ----------- --------------- -----------------------------------------------------------------------__Private [K Character of soil to a depth of 3 feet: Sand ❑ Silt ❑ Clay ❑ Peat ❑ Sandy Loam e Clay Loam ❑ I Hardpan ❑ Adobe ❑ Fill Material --- yes, type___ ___ (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) 10 NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) +113 PACKAGE TREATMENT + • ` [ l SEPTIC TANK Js.[ ]] Size-------�--�(,--��- � �D--------------------Liquid Depth. � - -------Q Capacity__.f(._Q49�rrfype..- RSI 1l+�a v4atarial_�p++ t----No. Compartments------I;L---------------------- {� Distance to nearest: Well -------- _------Foundation---_---------------------_Prop. Lin No. of Lines---------------------------- Length of each line--------.--------------------.Total Length.___,- _X-.---___..___----__-- ._ � _ . -- j /f `D' Box._._� __.Type Filter Material__2___ Depth Filter Material.___ -_ __-.____________________________ ___ t [ Distance to nearest: WeIL_)D-O----------------_Foundation-----/0-A-0________-Property Line._,, __-.__________.._ SEEPAGE PIT [..j Depth_______-._____.Diameter____________________Number___.______._.______._______ Rock Filled Yes ❑ No ❑_ , WaterTable Depth-----{--------------------------------------------------Rock Size------------------------------------------------ Distance to nearest: Well___________________________________________Foundation--------------------------Prop. Line._________-______._._.__._. tr REPAIR/ADDITION (Prev. Sanitation Permit# -----. ------------------------------Date___----_--------------- _---_--------_-----) pp . Septic Tank (Specify Requirements)--------------------------------------------------------------------- --------------- -------------------------- DisposalField (Specify Requirements)--------------------- --------------------------------------------- ----------------------- ------------------------------------------------------- r (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,, signature certifies the following: - "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 tor cman�Compensation laws of California." Signed - ----:----- ------------- - ---------Owner r By-------------------------------------------------------- -------T-itfe_- - - - -------------------------------- (If other than-owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----------------- -n - DATE.----- f:3- � j�--- ------------- DIVISION OF LAND NUMBER --.DATE-------- ----- : ADDITIONAL COMMENTS_--___ - . T - - -- ---------- ? --� ------------ ------------------------------f------------------------------------------ ---- -- ----- --------------------- --- - -------------------------------------------- - - - ----- ---------------------------------------------------------------------------- ------- ------- -------------------------------- FinalInspection by......... �.. - --------- ----- ---------------------------------------------------------------------Date------- " -- 7,11------------------- EH 13 24SAN JOAQUIN LOCAL HEALTH DISTRICT F&5 21677 REV, 7/7h 3M l