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FOR OFFICE USE: ----------------------------------"tea--'------- FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT G SJ Permit No....7�..:_...__.. (Complete in Triplicate) , a 7.. Date Issued.................. This Permit Expires.) 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 describe This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: 90�� 5c, /SIV if �' v e ---.......CENSUS TRACT -------- - ------ -------- JOB ADDRESS/ LOCATION ..-•-• ;--------- _-----------------............................. Owner's Name......R.t?.�?.e? T....... .�?!r�1�----------------- ---------------------------------- n 3J` - %33 ,.s ,c NPoe'� ..... ---•-- _Frj? -507 ........... _erY--------- Address -t Ci ---.-Zip.. Contractor's Name .... .'.%!/1eT/S.l?!!/J� �...S�n/... "'_�license #'6^-''6 Phone .—'�.- 3' `�.r� �J Installation will serve: Residence f$ Apartment House.E] Commercial ❑ Trailer Court ❑ Motel E]- -Other.-__-::. ---- n :_-__-----::------------ Number of living units: ...... %...... ._Number of bedrooms_✓�...... Garbage Grinder ............. cYE Lot Size.....- / /-� ...-------------- ----- Water Supply: Public System and name ...................... ------------------ ••••••-----------------••Private Character of soil.to a depth -,of 3 feet: Sand Z Silt ❑ Clay '❑t.k Peat ❑ Sandy Loam ❑ Clay Loam ❑ _aafdpan ❑ Adobe ❑ Fill Material ............ If yes, type- s__.._......_ (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) NEW INSTALLATION: (Not septic tank or seepage pit perrroted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK (]r `� :Size ..... ........ :,__._.._...::-------------------- ----------- Liquid Depth ....... ------ Ca acit !.' 00 -- T e-_e?'c__-6?s_.Material--.__ q -9t- �G.-.__..No. Comportments ...... .'Z_____.-�---- .. Distance to nearest: Well ...... ....................... Foundation ----- ,7_q ............ Prop. Cirie--- !9..;5- ----- r` -'S'o -- LEACHING LINE [ ] No, of Lines.._... .:................Length of each line......_......_.____.. -.__..Total Length-..�._._ a -----.----- ---- .. 'D' Box._.-./. .... .Type Filter Material. V.5 K ._..Depth Filter Material -__-P- .._..------------------------------------- ..- - e cJ Distance to nearest: Weli_..,..�?.p_ Foundation__... y ........... Property Line _...''..�.................. -_ Rock Filled Yes Nc SEEPAGE PIT I ] Depth................Diameter.____.... .....Number......_.___......-.� -- •---- � WaterTable Depth .................................... ..................... Rock Size -------------------------------- ..--------... Y Distance to nearest: Well ...............................-------------- Foundation. -------_------------_ Prop. Line-----• ---.-- --- -� .. REPAIR/ADDITION (Prev. Sanitation Permit# .......................... .......................... < - s)h- ............:......�---Septic Tank (Specify Requirement -------------------- Disposal Field (Specify Requirements)._...................... .----••. -- :................. r----- ------------------ -------- ...�,--:— --- � = ....:. �=-............ ........................ - -- S.....-•------------------- ------------•--------------------------- - -------- ------.....----...-----•---------.--------------- ... (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 Co OrdinaniCes, State Laws; and •Rules and R44rula.tions of the San Joaquin Local Health District. Home owner or licensed ag signatuWcertifies 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 manne to become subject to Workman's Compensation laws of`California."% ` Signed. E' !Owner BYE... Title .... _... �.., ..............�- (I b er than o ner) APPLICATION ACCEPTED BY__ DIVISION OF LAND NUMBER._ ADDITIONAL COMMENTS....._. FOR DEPARTMENT USE ONLY DATE ...... . DATE------------------- ---- ----------- IK.f.......- ------------------ I ---- .............................................. ....................................... -•-............---•-----•--.....-------------------------------------- -------------------•-------.......i ----- .-------------------------------------------------------------- ---- ----. ---• •----•--•..._._.. ------ .---------------------------------------------------------- — - Final Ins ection b ---.-----Date ........ .......... ----7 .._.... EH 13 24 SAN JOAQUIN LOCAL HEALTH DISTRICT F&S 21677 Rk A,