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FOR : // ------------------------------OFFICE-----USE----- APPLICATION FOR SANITATION PERMIT----------------- Permit No. (Complete in Triplicate) f" p -------------------_-----_----------------------------- This Permit Expires ! Year From Date Issued Date Issuedc2_-_ =_!U7 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 �h 549 and existing Rules and Regulations: ,Boos E-44 r^�f' J JOB ADDRESS/LOCATIONP!tt TRACT -----k---------------- Owner's Name ------10-6 t /---------------------------------------- ------ Phone Address .�z�yr '- ,0.S - � r _ " ------------------------------------------------ ------- -------------------- - / '- _ ------------------- City Contractor's Name -..'r .L7.4h_______ ________License #070350.---- Phone Installation will serve: Residence 9-Apartment House❑ Commercial ❑Trailer Court f] Motel ❑ Other --- ------------------------- IVO . _ Number of living units:-- Number of bedrooms Garba a Grinde� Lot Size _ or Water Supply: Public System and name -------------------- -•---------------------------------------------------------------------------------------Private Vg-' Character of soil to a depth of 3 feet: Sand' Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ 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 reverse side.) NEW INSTALLATION: (No s is tank or seepage pit permitted if public sewHisay .able within 200 feet,)PACKAGE TREATMENT [ SEPTIC TANK'[Ii]� Size__. -- Liquid Depthr Capacit� _ Type FAD--- Material_1 �1_ _l.e_ No. Compartments _ __________ U istance to nearest: Well -------6__a_____________________-Foundation --/.P-------------- Prop. Line ----- -------------- ti If LEACHING LINE No, of Lines ___ ----------------- Length of each line-------- Total Length ----I_6T_____________- ai ` 'D' Box A_________ Type Filter Material ROS_ ------Depth Filter Material --------- _______________________ Distance to nearest: Well ___VD_______________ Foundation -)Q------------------ Property Line -----tD_____-_-_-___ SEEPAGE PIT [ ] Depth _____ Diameter _______________ Number ---------------------------- Rock Filled Yes ❑ No E❑ Water Table Depth ------------------------------------------------Rock Size --------------- Distance to nearest: Well ----------------- __.-----------Foundation _ Prop. Line --_-____--____-___ REPAIR/ADDITION(Prev. Sanitation Permit# -------- -- --- ------ ------- - Date" ------------------------------- ) Septic Tank (Specify Requirements) ---------------- " � -- ----- ---------------------------- --------------------------- Disposal Field (Specify Requirements) -,D11_E.....�3.....� � �T��-"-_TJ��L,r� - ---1�..... �a�p--------- nN w At-L-L Tt1fcJcFD 5; INTfII— ><D55'T__�i+�1------- S N�i'T' �_ 5_cGNDR5 W1T+ A - D/spas 4, ------------------------ (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 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: "I 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 Wor an s Compensation laws of California. Signed ------ Owner By 'V �L�- Title C ----------- ------- - ---- other than owner) ,t FO EPARTMENT USE ONLY APPLICATION ACCEPTED BY ------�--(-R-�-------------------------------------------------------------------------- DATE ----- '� - -- BUILDING PERMIT ISSUED --- ------------------------ ----------------------------------------------;--------------DATE -- ------------------- --- ------------- ADDITIONAL COMMENTS ___ ------ ----------------------------------------------------------------------------------------------------- ------------------------------------ --------- ----------------------- - --- -- ------------------------- ----------------------- ---------------- ---------- -- -------------------- - ---- - ---- - --- -------- - ------ - - -- ---- - - -------------------------------------------------------- - Final Inspec Date --.----- '---- ---- ------ - SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'b8 Rev. 5M .. -