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FOR OFFICE ,USE _y �� APPLICATION FOR SANITATION PERMIT �jX_gl ----------------------------------------------------- Permit No. (Complete in Triplicate) ------------ ------- ----- ----- ------ ---------- --- --- -------------------------- 0 I. I � Date Issued ____________________ This Permit Expires i Year From bate I`sued _ , ' (V 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 NO'!549 and existing Rules and Regulations. JOB ADDRESS/LOCATION! _/_ I---;. �-'----_��1_C L R/Y----�3.D`- --------------------CENSUS TRACT __ ---f� -------- Owner's Namet SC`H_! _� - �, - i Phone Address ----JI-721....... --------V IC-T_?-K/)11--------RD..... City ---------- ------------------- Contractor's Name ....QLl{ F_R------------------ ------------------= -----License# ------- -:-------------- Phone s ' installation will serve: Residence Apartment House-E] Commercial-:[]Trai er Court ❑ ( � Motel ❑ Other ----- Number of living units:-----1---- Number of bedrooms --3__-____Garbage Grind;erlt __ Lot-Size _WPZ_EA-� =n--___------ Water Supply: Public System and name - -------------- - ----------- ------------------------Private Character of soil to a depth of 3 feet: Sand'❑� Sil ❑ Clay ❑ Peat❑'? Sandy Loam .0 Clay Loam- h `"°""`""�IaFdpan A `obe ❑ .Fili'N4aterial ___-- -`Ifyies, type --�' _ �] r (Plot plan, showing size of lot, location of system in :relation to-wells, 'buildings, .etc. must be placed on reverse side.) NEW,INSTALLATION: (No septic tank or seepa Pit permitted if public sewer is available within 200.feet,) •� SEPTIC TANK, �� \ a PACKAGE TREATMENT [ ��. [ Size-- _-- -- --t'�__X___ ---_:_- Liquid Depth ---- .-------- �` _CapacitylfSQ_Q_ _. T` e ��5�MaterialCQir"ET_F�fo. Compartments ____�:.._______- a - pe ---- �------I . . - I p t Can e V. -to-nearest: Weil _____ ______' ____- .__-_Foundation ___- Prop. Line-____�.__'+`______ ' ` �=_ `} Length of each line---- Total Len ;% �� _---------- LEACHING LINT_ . .[" �No. of Lines ' _._ ______ g g � -- D'. B. ,__�5- T e Filter Mater I R _ p i o�1� ! i /� ,yP ,-Ea -------------De �♦� Filter Material �� -----•---------�------•-•---- Distance to%bedrest: Weil ___149 _-______�Foundatttiio ___ _ fi----- Property Lirie SEEPAGE P17 [ Depth ---�� _._.______ Diameter _, ___ Number --____ �_ ____ Rock Filled. ;Yes t 'w ❑ r / " Kr [ t Water Table Depth __-- -9--_--------�-------------------------Rock Size ____2x— Distance _y__ f Distance to nearest: Well ._fN9-----------------------._-_Founclation .1219-1___-_-__-__ Prop. Eine __._. ........ REPAIR/ADDITION(Prev. Sanitation Permit# ----------------------------------Ix--- Date ----=-------_---------------------1 K r✓ Septic Tank (5pecify'Requir`ementsl -------------------------------- , - --------------- Disposal Field (Spec --------------------------------------------------------------ify 'Requirements) ------------- ------------------------ =--'-"--------------------- -------------------------- - -„ ------r -------- -- --------------------------------- ------------------------------------------- ---------------- ----------------------------------- - w� ! (Draw.existing and required addition oh yeverse side) I hereby certify that I*ave prepared this application and that the works will be done rin accordance with San Joaquin County Ordinances, State Laws, and Rules and Regulations of the San Joadu-in Local Health District. Home owner or licen- sed agents signature certifies the following: "I certify that inithe performs e F t work For which this permit is issued, I shall not employ any person. in such manner as to be co bject to Work a s m n fawn of California." I Signed ` -------- ---------------------------------- Owner By ---------------------- --------------- = ---------------------------------------------R_0J----- Title -------- ---------- --------------------------------------------------- (If lother than.owner] FOR DEPARTMENT USE ONLY . p APPLICATION ACCEPTED BY1:-----T-R_V--------•----------------------------------------------------- -----. DATE ----J BUILDING PERMIT ISSUED _-------------------------- -------DATE ---- ---------------------------------- ADDIT'IONAL,COMMENTS ----------- ------------ ----------------------------- --- ---------------------- ------ ------------------ ----------- --------------- ----- --- ------------ ----- - - - / � '�� - - -------------------------------------- = - ------- -----------------•---- -- ----- { Final Inspe tion by: ---- -- ------- ------ ---- 4 - - --------------------------- -.Date ` -- ----- t ; SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'88 Rev. 5M ::