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``FOP OFFICE USE: APPLICATION FOR SANITATION PERMIT �9 r9� ��-- Permit No. ------- ------------ -�� {Complete in Triplicate a-------- �--= Date Issued _.J�-_--------��'/ --This Permit Expires 1 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 xisting Rules and Regulations: described. This application is made n compliance w' County Ordnance No. 549 and e JOB ADDRESS/LOCATION .---- � ------------ CENSUS TRACT _ -- --- Phone _-_ Owner's Name 7 ZS f tY AddressCi �' NhoneLicense # ------ Contractor's Name Installation - will serve: Residence ❑ Apartment House❑ Commercial !❑Trailer Court '❑ Motel ❑ Other -------------- ---------------------------- Number of living units._lNumber of b oo st._- - arbage Grinder . Lot Size------------------------------------•---•---- Water Supply: Public System and name ------ G._ ---t__ ---1----- ---- `';-------'--------------- Private ❑ Character of soil to a depth of 3 feet: Sand El Silt❑ Clay Peat E] Sandy Loam ❑ Clay Loam [I Hardpan ❑ Adabe, 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 s-ide.} NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) r ' -- - pth PACKAGE TREATMENT 'SEPTIC TANK Se_ ____--/4 Liquid De Compartments .-_..-.-.-_---- Capacity Type 'p-- Material Distance to nearest: Well -------ti"—-------------------Foundation -- ---- --------- - Prop. Line -r-- --- -----•- I f Total Length -- �-`------------ Y _ Length of ach line__---- - - rz LEACHING LINE No. of Lines ---------- ------ 9 g - ' y � &__-6epth Filter Material 'D' Box _ Type Filter Material �. f 1----- ------ Property Line --- - o nearest: We .....________________ Foundation --- --- Depth y-------- Diameter ---_--- Number ._----._--- Rock Filled Yes No SEEPAGE PIT [ P i f A-. // ---� �-- Water Table Depth -------- - --------------• -•---- Rock Size __.0-_l2/l / Distance to nearest: Well _----- ---•- Foundation ---1/------- Prop. Line Z5----------------- r Date ---------------------------------- REPAIR/ADDITION(Prev. Sanitation Permit } - - . --t --------------------------•.--------------------------- Septic Tank (Specify Requirements) -------------------------- - Disposal Field (Specify Require,ments) -------------- =--------------------- -- ---------------- ------------------- ------ ------=------------- -------- (Draw existing and required addition on reverse side) ce I hereby certify that 1 have prep nd Rules andthis jcation and Regulationsthat the work will be done in acco of the San Joaquin Local Health DistrctnHo eitowsner or Iter County Ordinances, State Laws, sed agents signature certifies the following: "`I certify that in the performance of the work for which this permit is Tissued, I shall not employ any person in such manner ias to become je t to }Norkma Co pe ation laws of California." 1 Owner Signed ------ ----- =J-S - �------- - ��--- / �------- ---------- - ��✓ ----- - Title ----- - ---- (if other tho er) R .DEPARTMENT USE ONLY qy TDA ---�--2 ` E - APPLICATION ACCEP7i_D BY ----- ------- DATE BUILDING PERMIT 155UED --------- ----- ----- -- -- ----- ------------- -------- --- ADDITIONAL COMMENTS - CJ`f� ------------------------ '``---------------------------------------------------------- ----------- - - -------------------I---- V k ------------- ------------------------------- ---- ----- ---------- --- --- ---------- Date _ i Final Inspection by: --- - "-- - SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'b8 Rev. 5M. '� _'