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FOR OFFICE USE: ' APPLICATION-FOR-SANITATION PERMIT <. . - ----------- ---- (Complete in Tripl(tatel Permit No. lT ------- ---- This Permit Expires Year From Date Issued Date Issued if { I Application is hereby made to the San Joaquin Local Health District for a permit to construct and i , described. This application is made in compliance with County Ordinance No. 549 and existingt install the work herein JOB ADDRESS/LOCATION _ �7�./ Rules and Regulations: Owner's Name ___"_"- D--- ---- - ! F -C14A_RL_FS__ ` ` - -----:----CENSUS BRACT s �Y Address 7 �,�- --�-��__-T.'rl - l � [.\jj�--- Phone - "-""- --- . _ Cit Contractor's Name BWN. �l - YSG . �' I , License # -.----- -:--. . hone ❑ - ---------- Installation will serve: - --- �- - --�"-- - -------- k - �• ------ � Residence Apartment House Commercial❑Trailer C urt I Motel ❑Other I , to Number of living uni#s:_._INumber of bedrooms Garbage Grinder �Dr_- � • ' . . Water Supply: Public System and name Lot Size__�Ci /�C�f . Character of sail to a depth of 3 feet: Sand' CIO r -."_."-__._."_."-"_"__---------------- Character __-_- _ ❑ S11 ,! i Private _, _ y Pe Sandy loam Clay,'loam Hardpan Adobe Fill Material -V0: if es y type------ '` _ Z- (Plot plan, showing size of lot, locastian of system in relation to welts, buildings, etc. must+b NEW INSTALLATION: a placed on reverse side.) (No septic tank or seepage pit permitted if pub sewer is available within 200 feet,) PACKAGE TREATMENT 11 SEPTIC TANK.[ ] l '° Size__"--__�-- ----- - --- ---- ---------- ---- - Liquid Depth -------------------------- Distance ------- ----------- - Capacity ------ ------------- Type ----- ------------- Mat Mat rial---------------------- No. Compartments Distance to nearest: Well - __"_l _ ...... N LEACHING LINE ) ------- ------Foundation .------_--- [ ] No. of Lines _ } Prop. Line - ----- ---==-Ytength of leach Line-----" -- ----------- Total Length D' Box ----------- ------------ ' Type Filter Material "--" " ki ------- ------Depth Filter Material Distance to nearest: Well "._ - SEEPAGE PIT ,Property-Line Nu ber - Fou dation.._. i ��_ [ ] Depth -------------- ----',Diameter , --------- Rock Filled Yes ❑ No ( Water Table Depth �❑ --- E.� Distance_-to,nearest: Well .---- Rock Size v ----•----- ------Foundation l REPAIR/ADDITION(Prev. Sanitation Permit# --------.k-_--___" Prop. Line -------------- __Date-------------------------- Septic Tank (Specify Requirement ---------- ----------------------------------- ------------- '----------'"- ------"------------ --------- -------------------------------------------- Disposal Field (Specify Requirements) _----- �C1STi�.� r C -'�K-- - yrs:;- c=T_ ' o fc{+ Ll - ' `-------- EPRC� �1 1 r -- .- --- _ ----- I h '(Draw existing and requ1red addition ori reverse side) --------------------------- ereby 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 rFormance of the work for which this permit is issued I shall not employ an as to beco sub' to arkma ompensatian laws of California." p y Y person in such manner a Signed -- - ----- -------- - ----- ----- ------------ -------- Owner k BY - -------------------------------------- - r (If other than owner] Title ----- ------------------- i ------------- ---------- FOR _DEPARTMENT USE ONLY 'LICATION ACCEPTED BY --------- R_ !Z7,._"_ I �/' , y ONAL COMMENTS T__ 4=- "._ __ =..- ` DATE ".._//___ ------------ G--PERM-IT-ISSUED ------- -- __ -----------"_------- .- ---- -� _ -_-DATE--- -_-- -:—�-_ n?i r llF-l�1i-t4t -- ---------- - + ------- ---------------------------- �. _ 1L ------ - ------- -R----------- --------------------------------------------------------------------- t :.on-6y: ---------------------- - ---------------------------------------.Date ----- -- --�- --- SAN JOAQUiN LOCAL HEALTH DISTRICT L-'68v. 5M