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FOR OFFICE USE: ! _ FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ----- Trip -d7�7� :. !, �, Date Issued._"-__.------ This Permit Expires 1 Year Frone;Date Issued ;i 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-' rdinance No. 544 and existing Rules and Regulations: Rj JOS ADDRESS/LO T,I,ON � �!_-f =_.._f .:.-.- l rQ -------- CENSUS TRACT . Owner's Name. (L1J QQ_1�_4.�O;kC Phone per!_^.7 •} ! Ike Ql�----- ------------Zip---- ------ d Address . -" f 1 J:_..... ----- C�t1/ Contractor's Name- -- ------------- License #- �r? h Phone c363. --�3 Installation will serve,. Residence Z4/Apartment House ❑ Commercial•❑ .Trailer Court ❑ Motel ❑ Other.-.t----- - == = Number of living units:------- _______Number of.bedrooms- .-__Garbage,Grinder__.=.__._ Lot Size._, �i�-_acxe-.___________________-------_--- Water Supply: Public System and name------------------------------ ---:----------- ' fir...,-.__.: . -----------,- . ..-----------------------------Private Character of soil to a depth of 3 feet: Sand 0 Silt❑ Clay Feat-❑' Sandy Loam ❑ 1 Clay Loam ❑ I Hardpan ❑ Adobe ❑ Fill Material------------Dyes, type_.__. _ __ (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. m st be placed on reverse side.) NEW INSTALLATION: iNo septic tank or seepage pit permitted if, public sewer is available within 200 feet,) . PACKAGE TRE r� 4 ATMENT [ ] SEPTIC TANK Size----- y __ -_ � �� Depth ` G �= - r ---M�l�f�- Qa �-��--- �j�Liquid .__�� -- -----� lc _ -.No. Co It Prop. ------------------- ----------- IN Capacity...� QCU------ TYPe � f Distance to nearest- Well- ------ ------ ---------.- - Found �.--- -^=^- Fp. Sine_._-v� C Foundatio > LEACHING LINE. [{-]� No, of Lines_ _____________________Length-of'each lins "-_= .Total Length._-_-,-,, _ n'--- �-- --+---- Pro L/..Z-O-------------- - 'D'.Box-_/4....TYPe Filter Material=___- - -__.--°Depth Filter Material---------' ---------------------------------------- g Distance,to nearest: WelL___c _Q_�_ ____ Foundation__cl�,�' :�.__._.-_.Property Line----------------------------------- ,y - ' `� Rock Filled Yes SEEPAGE PIT .[iy' Depth___��_3-___.Diameter___33.___.____Num)Jer_______ �_'0�.___ [�/No [] 4 f ��`^--------- =----- > Water Table Depth Rock `'J + f Distance to nearest:,Wela-=-----.�� c.._y-- Foundation---- ��------ - +;Prop. Line._ie. ___..._-.-_ _-.-. REPAIR/ADDITION (Prev. Sanitation Permit#"0 - %-_ w+_~"/ - - - - Date�---=--------------------- Septic Tank (Specify Requirements) --- ------- ----- -j ------------------------ --�____ ------------------------ --------- 4 - - Disposal Field (Specify Requirements)__.,_______„_ _-_-_ - ------- ... - ---=-- -------------------- ------------- ---------- I - ---- ----- - - ----------------------- 4�} � t (Draw'existing and required addition on reverse side) I hereby certify that'I have prepared this application and that the work will-e/ done in accordance with San Joaquin County Ordinances, State Laws, and Rules and Regulations of the. San Joaquin Local Health Disteki. Home owner or.licensed agents signature certifies the following: i "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 Wo man's pensation. laws_of California,' _, _ s ! Signed-------- - --- -- --- ----- ------------ ------.. r .-. -- ------ OWner BY j----- - - Title �GP/�'1.!/� -------- _ ` (If other thanowner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ._ ' DATE.... = DIVISION OF LAND NUMBER'--------.------ -=---------- ----.:--:-----,----- -:----.-------------.------.-------- -- ---DATE---------------- ------------------------------ ADDITIONALCOMMENTS------------ ------- ----------------- ------------------ ----------------------------------- -- ------------------------------------------------------ ----------------------------------I- ------------------------------------------------------ -I- - -----------------_-------- ------------ ---------------- --- ----- ------------L-- -- -------------------------- 7. ---------- --- ----------------------- ----------------------`------------ -- ---- -- ---------------- ._ ------------------ -------------- -------------- -------------- - R --------- ------, --- ------ ---- � -------- Final -- -- - .y---- ”' .L Date._ Final Inspection b J J EH 13 24 --�� S JOAQUIN LOCAL HEALTH DISTRICT F&s 216» REv, 7i�6 3M W _ 4 w I -/