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OFFICE USE: j 1 - APPLICATION,FOR SANITATION PERMIT FOR OFFICE USE: -------------- --------- ------------- -- (Complete in Triplicate) Permit No.__71'--�7 -------=--- ---- - -- -------- This PermitlExxtpires 1• Year From Date Issued Date Issued_=_3�=-7i 5 Application is hereby made to the San Joaquin Low Health District for a permit to construct and install the work herein described. This application is made incompliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION_~"____6, Z �. T - . ,�n�, ----------- - -- ---- -------- -- ----- ------ .CENSUS TRACT.-- Owner's Name---- -------- D ' , --- CJI. Address- ------ - U. n _4=-- -------------------------.. -- ------ --.Phone--- - --- - : --- -- - -- -- ------- -- - r ---------- ----ci Contractor's Name--- ------- - ----- lczl_ � Zi --------------- ------- --- - License #_254, ' ---------------?----9-------0-----7 Installation•.will serve: Residence � 3_____-Phone____ ____ ❑. Apartment House ❑ Commercial ❑ Trailer Court ❑ i . Motel ❑ Other---- ---------------- = Number of living units:------l-.____._ Number of bedrooms.--2 Garbage Grinder- ------- Lot )ter Supply. Public System and name----------- ------- ❑ --- ------ ------- -----------------Private _ Character of soil to a depth of 3 feet: Sand Silt, Cloy 7 • � ❑ ❑ 5 y ❑ r Peat Sandy Loam � Clay Loam r an Hard P ❑ . Adobe ❑ Fill Material_-----------If yes, type_______________________ (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•see' page pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ J SEPTIC TANK Ii !U� YP --------------------- _ ---_�---�r------- -------------Liquid Depth.__. f F Ca )cit J --� P Y :Type -- ---- _Material -------=-----No. Compartments-------- Distonce to nearest: Well_-.._-----s5b._�"------ __ r r Foundation ------ LEACHING !_INE (A No. of Lines------ ----------------- : Lenth of each Prop. Line _ --------------- _____ g. ------.Total Length .-.- Z(d { D' Box__--------- Type Filter Material°. - Depth FilterMaterial f - r 1 ----------o-*---------. I ( a_1*- 4 a i } --------------Property Line ---� -+--- SEEPAGE PIT 1� Distpnce to nearest: Well_._.___�_"Q__.__ _____._Foundation__...__�_ ( ]r' Depth--- -- --------Diameter--------- Number -."__ k Rock Filled Yes ❑ No ❑ y t Water Table Depth. --------- -- ------..Rock 5iie-- ---------------- Distanceao nearest.-W. II— . --}r-=.,-)----------Foundatio--- -------- ------------.Prop. Line---------------- REPAIR/ADDITION (Prev. SanitationPermit# : ______:_________________ �_ �' -- ---- Date`----------- -•------ ii -------- --------) t i Septic Tank (Specify Requirements).__._ P (Specify q ) ------ ------------- = ------- -----------------4 J� -------------------------------- Disposal _ Dis osal FieldRequirements):::: _�yt.:_ _:- ----------- --- - ----------------------------------- r - ------------------- - ------- --------------- fe --------------------- -------- ------ ------------------------------------------------------ - _ r _ (Draw existing and required additionrevere side) 1 hereby certify that I have prepared this application and that the-uVoikV' ill i-%e+dore-in accordan e�with San Joaquin County Ognatureecertsf es the following Rules and Regulations of the San Joaquin Local Health District. Home owner or licensed agents 461 ceifiify that in the performance of the work for which-this permit is issued;l,shall not em to an, w to become subject to.Workman's Compensation laws of`California." , I p y Y person in such manner as 4 Signed - ------------------ --------- ---1-- .O4 lIV 'ti- BY-------- ------- ------ -- ---- e------- Titl ----------------- other than owner) g FOR DEPARTMENT USE O LY 7 ,�� APPLICATION ACCEPTED ' ' --------- 4 ------------------------- DATE DIVISION OF LAND NUMBER______________________ __ t --- ---------- ----DATE - --------------------------- - DITIONAL COMMENTS------ --------- ---- ---------- - ------ f' --------------------------------------- ----- ---------------------------------------------------------------------------------- --------------- ----------------- --------------- t - Final Inspection by----------- ---- - -- - r -- ---- --- --v-. -�--------------- -----------------_-Date.-- -/�J EH !3 24 - ---cam--:- - ----------- SAN -K----- --', SAN JOAQUIN LOCAL HEALTH DISTRICT F&5 21677 REV. 7/'' 1