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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No: ---- �•-------- ---- ----- ----------- ---------- [Complete in Triplicate) ---------------------------- - Date Issued This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Health District fora permit to construct and install the work herein in compliance with County,Ordinance No. 549 and existing Rules an described. This application Is made p d Regulations: Jg u y o�` e� e� ;14r® ---- JOB ADDRESS/LOCATION .`�1 l - �//: = CENSUS TRACT, ' Name '(7LlL�iQi4nJfi_ _"%ice - ------------------------------------- OwnersPhone 33 � �� ✓ ' - city ------------- -- Address ------------��.'_ ---- ---- Contractor's Name f �,/fl'"" Edi✓ 4Mitg71 " 1iJ0 -------- ----------License # -lu-l; � -- Phone `fid __ ' " /.-- Installation will serve: Residence X Apartment House^❑ Commercial :❑Trailer Court ❑ Motel ❑ Other -------------------------------------------- Number of living units:_-- -._-__ Number of bedrooms _Y-----Garbage Grinder Ap--- Lot Size ------------------_---------_- -_---_ Water ------------ - :-- ------------------------------------------Private, Character pofl soiI tola depth of 3 feet me "Sand❑ Silt❑ Clay ❑ Peat'❑ Sandy Loam •❑ Clay Loam Hardpan ❑ Adobe-❑ Fill Material ---------- If yes,type --.------------------------- (Piot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on rever ode.) p ' seepage pit permi ed if pfrTJKd ewer is availc �e within 200 feet,]{NEW -�� PACKAGEATR TREATMENT I I septic talk or -,i/""�'"."--- Liquid Depth --��4�-- I VIW J/�q---- q P Ca acit �------- Type C t '9�"" Material--C`oo'-`,474_ No. Compartments """"_-�f.------- P Y1 YP ------- -- Foundation ------4Q- ------- Pro Line ---------------------- Qistance to nearest: Well _-__""f.Ol7�""-------------- - CC � - P' � ? LEACHING LINE [ ] No. of Lines "".__-_. ---------- Length of each fine__-."- 4-a- Total Length.---- ----------- Total ii k D' Box " " ! rMate'riai 5�K_1�Y"-Depth Filter Material -------l- "--------------------•- 01 4 i ----------�------------ Distance to nearest. Well "_-_�_ _ Foundation ___� -------------- ------------ Property Line S SEEPAGE PIT [ ] Depth --------------------Diameter ----------------t-Number "4.--- ----- Yes E] No !❑ _ Rock Filled Water Table Depth----- ------ --- ------------------------- Rock Size Distance to nearest: Well -- )Foundation ---- --------------- Prop line ----------------•----- REPAIR/ADDITION(Prev. Sanitation Permit# ------'---------- ---------------------- Date ----------------------------------) /0��0_'�� ocl"-" ------------------------------------------- Septic Tank (Specify Requirements) ---- --------- ! -- ------------- ---------------------•--------------- DL' ,L(.rhe-------------------------- -------- ------------------•--------------- pisposal Field {Specify Requirements) ��--------��--�---- "--------- " ,. ------------- - --------------------------------------- y; -"""y _ i ------------------ -------------------------- g required and `--- . aw exist er -b certi" -_-that I have -" rth s app)cation and thatathe Iwo k will on on rbe se sdone in accordance with San Joaquin Iheey certify prepared 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: "1 certify that in the performance of the work for which this permit is issued, I shall not employ any person in such manner k CALTJd O.Tb Epr�if*'+�;tclN.orkman's Compensation laws of California." P.O. Sxgfiie2�' --]11,--3-3473 Owner SaCr------to 21Calif. -" - --�'ys------- Title - -------- ---- ---- - > I (if other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ---/ ' k� -----. DATE -. '_�,4/f 6 ------------------ DATE BUILDING PERMIT ISSUED --------------------- - ------------------------------- ----------------------------------------------- - -------------------------------- - ADDITIONAL COMMENTS ---------------------- ------------------------------------------------------------------- ----- ------------------- -- "---------•--- r -� -------------------------------------------------- ----------------------------------- ---- - - -- - -- -- -- -- - ---------------------------------------------------------------------------------- -------------------------- 4 Final Inspection by: -- Date SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'b8 Rev. SM