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FOR OFFICE USE: FOR OFFICE USE: APPLICATION F8R SANITATION PERMIT � 1 Permit No. i Z b0 __/b-r -- ------------------------ 9 (Complete in Triplicate) L. 111 ------- �s--29 -------------- ----------- --------------------------- Date lssued.,3-.-- ---- This Permit Expires 1 Year From Date Issued -s ----------- `.Y Application is hereby made to the San Joaquin Local Health District,for a permit to construct and install the work he described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION 1� --��------ -------------------------------- CENSUS TRACT-------- -- --------- -------- . F Owner's Name ------- �/,� ------------Phone-----------.------- ------------------- ---------- y ---------- ------ -------Zip---=---- TAddress------------- --- � 1 - Cit - ----- ► ✓ I Contractor's Name-----_ --- _ _ — ---License # .- -. Pflone------------------ �" Installation will serve: ,. Residence Apartment House.❑ Commercial ❑ Trailer Court ❑ k Motel ❑ Other---- --- =---------------- ------------- Number of living units__________ _____Nun ber-of-bedrooms ms---�-_Garbage Grinder-..---------Lot Size----�_�� Water Supply: Public System and name--_ --.-___- --------- - - - - ----------------------------- Private Character of soil to a depth of 3 feet: Sand ❑ 'Silt[] Clay ❑ Peat[I Sandy Loam Clay Loam ❑ Y p obe ❑ i` .Fill Material------------If yes, type------------ ------------------- I p Hardpan ❑_, Ad �ki (Plot plan, showing size of lot, location of.system-in relation to wells, buildings, etc. must be placed on reverse side.) CP :._. NEW INSTALLATION: - (No'-septic_tank or se Jpage pit permitted if public sewer is available within 200 feet,] •: PACKAGE TREATMENT [ ] lSEPTICTANK [.j Size__- --11f> . -�_-------_- ------------------Liquid Depth.---------------- - fMaterial__ C-1?,-a No. Com artments__,.- .------------------- > Capacity./ _ ---Type- p -Prop. Line------✓r'�------- ,.Distance•to nearest: Well_______________ �- -----------=Foundation.____ - " �j Total Length -.-- __ LEACHING_ LINE [ ,No,�of Linesr-_ __�z. ___'_.._,_-.Length of each ]ine:._____ a -------- ` P ---- Line - t 'D' Box -- -'-.--Type.Filter.Material;------ - � - Depth Filter Material-------..�------------------- Distance,to nearest: Well-------1X201-?_ _Foundation___--_/� .--Property tine._____. ------------- ------ SEEPAGE PIT [ ] Depth.___- ---Diameter------------------ Number...;----- -------:-------------- Rock Filled Yes L] No 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)---------------------- ---------------------------------------------- -- --- - -------------------------.------- -------------------------------------------------------------------------------•------ ----- -- ----------- ------------ ---- ! ( (Draw existing and required addition on reverse side) I hereby Certify that ! have prepared this application and that the work will be done in accordance with San Joaquin County tions of the San Joaquin Local Health District. Home owner or licens Ordinances, State Laws, and Rules and Regulaed agents signature certifies the following: erformance of the work-for which this permit is issued, I shall not employany person in such manner as "1 certify thatin the p g - p California." / i to become subject to Workman's .C�Compensation� laws of l 5i ned - -- --- - --- Owner _ Title ---- By- ------ ------------------- ---------- - (if other than owner) FOR DEPARTMENT USE ONLY -DATE.-3 I--- -- --- :--- APPLICATION ACCEPTED BY - �` ------------------------------------------- r ------------------------------ i DIVISION OF LAND NUMBER---------------- -------- --------- ---- --- ----- -- ------.DATE-------- --- ----------------- ...... COMMENTS----------- - ---------- --=-----------------=--------------- ------- ----- -----------------------------� =--------------------------------------------------------- F ___________ _� ____-----.---____-----___---___----___---__----____--.___---_____----___..--____-__.---.__--_ __--_ -_ _______________________ . I Final Ins ection b --- -- ------- Date.__"_ --------- ------------------- 1 p Y;-- .. EH 13 24 SAN JOAQUIN LOCAL HEALTH DISTRICT F&s 2r