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OFFICE USE: FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT OV (Complete in Triplicate) Permit No----- This Permit Expires 1 Year From Date Issued Date Issued__AT/17�-- 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 ----- .. 3-�-------- .�L �,7 fly= ----------------------------_CENSUS TRACT-------------------------------- Owner's Name.............J ---------TO// - ---- -_ -----------Phone------------- - Address- --- --- ------eep 33-- -------- ------City---X0 pa,5 P Contractor's Name------- .-- N7_f/�--o`+ / --.-_ '- / License # - Phone__ ,a- -/�__. Installation will serve: 'Residence Apartment House.❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other------------------ - -- - - ---------------- Number -------- - -Number of living units:-----f --.-----_Number of bedrooms. ---Garbage Grinder------------Lot Size--------------------------------- --- ---..-------------_--- Water Supply: Public System and name----------------------------------------- ----------------------------------------------------------- ----------Private ® . Character of soil to a depth of 3 feet: S'b,.nd E] Sfl#�❑ -Cla.y'❑ Peat ❑ Sandy Loam Clay Loam ❑ Hardpan E] 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 reverse side.] NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) �� •�, PACKAGE TREATMENT [ ] SEPTIC TANK [ ] Size---_6_X )e I->-------------------------Liquid Depth___;'"_)___K--------------- Capacity- ------Type.P.C4-_- A5j_Material--------------------------No. Compartments;---------- ------------ Distance ------ ------------ Distance to nearest: Well______ -------------------------------Foundation_L�____-_------- ._Prop. Line.-_ `-----------------Q LINE [ ] No. of Lines-J-7,, :T '__ gth of each line-Jq Total Length.--.�<"49------------------------- LEACHING D' Box...I-_----Type Filter Material-.1/19AR a th Filter Material__-- _ '�P P z Distance to nearest: Well_-'_C'-----------------Foundation_-ca -------- --_Property Line------- -------------------------- SEEPAGE PIT [ ] Depth----_-----_----_Diameter--------------------Number--------------------------------- Rock Filled Yes ❑ No ❑ WaterTable Depth--------- ----------------------------------------------.Rock Size.----------------------------------------------- I y, Distance to nearest: Well_------,----------------------------------Foundation---------.----------------Prop. Line.-_--_._----_.---.----.-- REPAIR/ADDITION (Prev. Sanitation Permit#--------------"'------------ - -----------------Date- -------------------------------- j SepticTank (Specify Requirements)-------------------------=- -------------------------------------------- -------- ----------------------------------------------------------------------- Disposal Field (Specify Requirements)--- ----- --- ----- -- ------------------------- -----------I------I-- --------------------------------------------°---------------. . ---------------------------------------------------------- --------------------+-------------------------------------------- y '--------- -------------------------------+--------------------------------- ---------------------------------------------------------------- -4_- --------------=-'=---------------------- - ' - F (Draw existingand required addition on reverse side] I hereby certify that I have prepared this applicatibri 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 certifythat in the i 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 Iaws_of.:.California." Signed------------- ---- ---- - -- --- ---------- -- -- --- ---- ----Owner BY--------------'l �� ------------------- --------'--- Title--------------------------------------------------- -------+ (If other than owner) V �. I FOR DEPARTMENT"USE ONLY r APPLICATION ACCEPTED BY------ '� DATE. 2-1 ZZ DIVISION OF LAND NUMBER----------------- ` -�' ADDITIONAL COMMENTS------------- ------ -- --------------------------- ---- --- ---- ._----------------------- -------------------------------------------------------------------------------------------------------------------- -- --------------- --------------- -------- -------------------- -------------------------------------------------------------------------------------------------- ------:------- ------------ - -------------------------------------------- --------- -- -------- ------------Date-- Z 7r7�{ Fina{ Inspection by 7 13 24 SAN JOAQUIN LOCAL HEALTH DISTRICT F&5 21677 REV, 7/763M