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4.1 f� FOR OFFICE USE: 7 " FPR OFFICE USE: c U APPLICATION FOR SANITATION PERMIT } `' ¢+ * mit No----------------------- �� 1 (Complete in Triplicate) "t -------- 3—��-7" - Date Issued____________________ , --_------.-_ ---------------------------_____ This Permit Expires 1 Year From Date Issued 9' Application is hereby made to the San Joaquin Local Health District fora 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: M JOB ADDRESS/LOCATION - -- .. --- >0z'vew------ C Com. .CENSUS TRACT-.--. Owner's Name----------- DQE Vz ee_6_----.....r.S/_� e �: - Phone. Address C -=6. .......... _..._ [�d�l if�.a -City '_. C'rq_ O. Zip---- - iP i, Contractor's Name--- 1�j ..__ Z)A2/� -_ :L_-.6� �-License # _ _Phone-__ Installation will serve: Residence ❑ Apartment House ❑ CommerciaLo Trailer Court ❑ v Motel E] Other tNumber of living units:----------------Number of bedrooms-------------Garbage Gr' der..:_.._.__,:_Lot Size------- _.el IF. ` -------- --- Water Supply: Public System and name------- --------- -- --i--- - -- ----------1--- --------- ----------------- ---- ....___-., , ---- --------------'Private 3 Character of soil to a depth of 3 feet: Sand ❑ Silt❑ Clay ❑r Peat❑! Sandy Loam Clay Loam ❑ { Hardpan❑ Adobe ❑ Fill Material_..._ _._.-_If yes, type-------- ---- ---- `T (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc, must be placed on reverse side:) f �; D- ------.-Li Liquid De th_n `/' } NEW INS ALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT- [ j SEPTIC TANK ['] Size-------------� -- q p - �! t Capacity/�-�� pe:_'id ✓ --- aterial/26_._-_---No. Compartments-------�--_- ------------- _?$/y —---_-_. - ---------------d�..-- -- Prop. Line- --1--40------------- Length ------=--- - Distance to.n ---- - - - �' • LEACHINGLINE [ j No. of.Lines_ g Barest: Well.-••---'� th of each li s.___Foundation- Total Length.__._,___ �.,__�_______________ ©�+ /, r/ 'D' Box-/-----.Type Filter Material__ _. e� filter Material.______I .____________n--.____ _ '__ ' i J n ------------ Distance to nearest: We'll---- ____ _.Foundation. ____ -___Property Line------- ___-_ __ ------------ SEEPAGE IT [ l P -- ------Number----------------------- ------- Rock Filled'_Yes[] No ❑ E kWater Table De th--- ------ .. ;.Det -.------ Diameter-------------- �; P --- ----=-------------;----------.Rock Size----- ---------------------;- Distance to nearest:Well------------------------------------------Foundation-------------.-_k ^- - Prop. Line----------------- --:------ REPAIR/ DITION __---REPAIR/ADDITION (Prev. Sanitation Permit#-----------------_----------------------------------Date--------------------------_------------------- Septic Tank (Specify Requirements)---------- ---- ----------r A R�� __�_-e�-------7OAd t w�.�.- k Disposal Field (Specify Requirements)---------/—I!r �------rrF "'�'_'t------ Pr------.-� Ldy ----------- -------------------------------- - * -- - ----------------- - ----- -----J `------}--------------'--= _3._��.r.�------------------- ------------- "-r- - _ t ------- - --------------- -- (Dr`aw existing and required addition on reverse side} l } I hereby Certify that,l have prepared,thisra plic Pion and that the work will be done in accordance with San Joaquin County Ordinances, State Laws, and- Rules and Regulations-.of+the SaYn Joaquin`Local Health District. Home owner or licensed agents I signature certifies the following: "I certifythat in the performance of the work for which this permit is issued, I shall not employ any person in such manner as to become sphiect,10 rkman's Compensation laws*of California.' s Signed . ' •_ ,f' `` , 5 .....................................Owner BYld 2 ---- -------------------------Title '�� -------- ---------------- .....• # i I. other than owner[ r FOR DEPARTMENT-USE ONLY APPLICATION ACCEPTED BY.- DATE. Z7: ---- ,.J DIVISION OF LAND NUMBER --------DATE --- -------------------------- ------------ ADDITIONAL -------------- =- ADDITIONALCOMMENTS - ----------- ------------ --------- ------ -------------------------- ------------------------------------- ------------ -------- --- -- ----------------- -- ------ ---------- ---------------------------------------------- -----=--- ----- ------------------------------------ -------- -------------------------------------------- ----- --------------------------------------- - ---------- ------------------------------------------ -----------------------------I----------------- -------------- -------------------- = -- - ------------------------ --------------- ------ j —� _ ., Date- �f Final Ins ec#ian b - -------------- - - EH 1324 5AN JOAQ N LOCAL HEALTH DISTRICT F&s 21677 REV.AA?4 3M if