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FOR OFFICE USE: FOR OFFICE USE: /APPLICATION FOR SANITATION PERMIT i ------------------------ ---------------------- F (Complete in Triplicate) Permit No. __11�p -----_- -.-.-- This Permit Expires 1 Year From Date Issued Date issued- n/,,5 -7___$� 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 N 549 and existing Rules and Regulations: JOB ADD RESS/LOCATION--------- --.-- -------- ---------:rte-r-___:- -- -- ..CENSUS TRACT - ------------ - ------- -.. Owner's Name-- •_ --------- -1Q ! - -------- . --.Phone--.F? ------------------- Address. -----------------Address. = =pis1City z-_i_P_ -- ----------- - - --------_License # PhoneContractor's Name---------- ?} e9_7777---- Installation Installation i will-serve: Residence Apartment House.❑ Commercial ❑ Trailer Court ❑ Motei Other ----- -------- -- 4 - -t- �_ - p. t rS Number,�of living units:.'-- Number_of_bedrooms_----------_Garbage.Gr,inder_.N_Q---LotTS��e_--_- Water Supply;;Publ•ic`System�and name--.,_i------_-- -_ -•.`-4 ,-. - -��" ,_ `. �y,----- --Private _ _— Character of soil toa depth of 3 feet: Sand5il't❑- -C-lay-O—Pear{ Sandy Loam-[� Clay Loam-❑ an Hard s P ❑ Adobe ❑ - Fill Material--- �41f yes; type-------------------------------- (Plot ------ -----------------------(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 er seepage pit permitted if public-sewer is available within 200 feet,] 11 P PACKAGE TREATMENT [ ] SEPTIC TANK -_-__-----_-___.---_____________________________Liquid Depth._____________________-____ . y [ ] Size_.� } 1 � � t ateridI_!_ __J------------------No. Compartments Capacity = Type--------- -- - s (f [ P �. Distance to nearest: Well--- -------------=-------h-y/._Foundation--------------------------Prop. .L.ine.-------------------------- INE ['] No. ofLinesi-----------= `.Length of each line--------------------------------Total Length.------- ------------------------------- U M . . . . J K LEACHING L D' 'Boz-- :--Type,Filter Mdte'ril ----- ------------Depth,'Fi!iter Material __ r zr►ca �. --- ------------------ ----------------------- `Distanceto nearest? Weil____ __ � ! - Q - ------------Foundation------�--- ------- -----.Property Line----------� --- SEEPAGE PIT [ ] ,, pihl�---------------Dia eter._-,.j{___.________Number____ ________ ___--_--_-----_- Rock Filled Yes ❑- No❑ _ -- Water]Table � Depth -----------b -------- i-Rock aSize ----- ---------------------`------------- -- -- �r r) Distande tonearest[Well---------- �---- -- ----- ---------- .Foundation---------------- ------.Prop. Line_------ =------------------ 1: f REPAIR/ADDITION,Preva Sanitation Permit# ----------- ----------------- _ ----- at - ----------r •------------ -----] Septic Tank (Specify'-FE quirements)��- - - ,; -= i ---- (L r ' i Disposal Field (5peeify Requirement]il- ".,7 L_ ;A j--_`------------------ - ---_-- --�/ ?v = e----- - -- # -11�:------------ ------ �------ -- --------- ------------------------------------- ---- ---- ----- j -------------------=------= hereby certify that I have "'re ared t`pa I ciatiori-and that owo '� in q i ition on reverse side) y y p p >, y pp rk will be done in accordance with San Joaquin County Ordinances, State Laws, ai'd Rules/ions Regulations of the San Joaquin Local-ilea th District. Home owner or licensed agents signature certifies the follovsning: "I certify that in the erformance of=the work for which this permit is issued, I`ahall not employ any person in such manner as to become subject orkrnan's�. om ,ensation laws of California." Signed- -- - Owner (' $Y-]---------------------------------( - �- -- �-._ __Title-----=-- 10 V1 O- --- other than.ow er '� ,'_ �"""�_ '"'. FOR DEPARTMENT USE ONLY."; APPLICATION ACCEPTED BY- =--------------------- -----:---------------- --------------- ------------------- DATE - l DIVISIONOF LAND NUMBER------ ---------------------------------=-------------------------------------'-- --------- ATE--------- ---------------------- ---- ---------- ADDITIONAL COMMENTS *= j �# ---------------- --------------- n = ---------------------------------------- ----------------------------- ' ----------------------------- ------=-----=----------- ------------ ---------------------------------------- -----------------------------------------------' - - - -- --------------------- ----------------- -- ------------------ s Final Inspection by - ='----------- - --------------------------- ----- " -----------------..-..--------- = Datgl 1 - EN l3 24 SAN JO QUIN LOCAL HEALTH DISTRICT &s 2,6»x/76 3M