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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT " Permit No. -? ----------------------- (Complete in Triplicate) -_ ------------------------------------------------------ This Permit Expires 1 Year From Date Issued Date issued SLI..... Application is hereby made to a permit to construct and install the work herein described. T��apllication is made in compliance with County Ordinance No. 549 and existing Rules and Regulations:. JOB ADDRESS/LOCATION .__.:____�g__ _ ______5d_�____ 0.7`_f�b _ '_`MnJe -'.- ENSUS TRACT -------5- Owner's Name --------- >-/4/y-----------Y-v----�------------------------------------ -------------------PhoneCf ------------------------ Address i4L--E'_ _ City ---/---9-- -,- r� ;Z_I Contractor's Name --- _�o---A-!V- 041 V----y� $p/Y- --------License #`K4(------FK- Phone ...... _ Installation will serve: Residence 0 Apartment House❑ Commercial ❑Trailer Court !❑ Motel ❑ Other -------------------------------------------- Number of living units:__________ Number of bedrooms _______Garbage Grinder _____�Pkl _ Lot Size .__ 0.-�_�.©__ ______________ GC q >- C/c� 2.�3_ Yi=_L f+ ffkriva#eWater Supply: Public System and name ___ _____ ❑ Character of soil to a depth of 3 feet: Sand' Silt❑ Clay ❑ Peat❑ Sandy Loam rg Clay Loam,❑ Hardpan Adobe Fill Material If yes,type ---------------------------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on Feverse side.) NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer1s available within 200 feet,) V PACKAGE TREATMENT [ ] SEPTIC TANK,f4 hh Size ___�+� _ �`__./a___.-_ __- Liquid Depth _t__ _______________ A , ,b_ Ca acity _-y _®_._ _C. Type YN_6k 5&aterial___- No. Compartments; ................ Distance to nearest: Well -------ICC' 1___"4-------Foundation -------1-0- Prop. Line :�7.......... _.-_ LEACHING LINE No. of Lines f;�-------------- Length of each line___ -__-;7-'d------------ Total Length __/Q�.......... y 'D' Box _._,/----- Type Filter Material Filter Material --------20-Z' --___-2Q_.°.......................... Distance to nearest: Well __ �� ___" '___ Foundation ------------------------ Property Line`- _-_.._............. I= SEEPAGE PIT [ J Depth --------- ---------- Diameter ---------------- Number ---------------------------- Rock Filled Yes © No 0 WaterTable Depth ------------------------------------------------Rock Size --------------------------.----- Distance to nearest: Well _________________________---__-________Foundation -------------------- Prop. Line ----------- .......... '- REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date _______________._____..________._) Septic Tank (Specify Requirements) 7.1`l_7/___-_ Pf7C_.SySt�f __1N, 7l1 -___ / L,��/(__-./�(fr-_,$T ,�TQ,_--. •{ +Lo - Disposal Field (Specify Requirements) ------------------------------------ •-- ------ --- -------- ---------- - --- ------1--- ----- ------- ------ --------------------------------------------------------------------------------------------------------•-------------------------------------------------------------- -------------------------- (Draw existing and required addition on reverse side) 1 hereby certify that 1` 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: "1 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 ---- ---------------------------- �01y --------- ---------------- --- ---- - ----------- Title -- Y. - `��` (If other t FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ----- 1-Rt--Q--------- --------------- ------------------------------------ DATE /.:= � �' ��-------- BUILDINGPERMIT ISSUED ------------------------------------------------------------------------ ---------------------------------DATE ----------------------------------- ADDITIONAL COMMENTS _' ----- --,-,------------------------ -------------- - - ------ --- ------- - -------------------- - ------ ------------- ------- ---------------------------------------------- --------- ---- - -`` -- ---- - . - -�- � /� - Final Inspection bY: ------- � - --- --- • Date -• - SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 M