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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT in Triplicate] {Complete Permit No: ---- ---------------------------------------------- This Permit Expires 1 Year From Date Issued Date Issued ---- ._..-._.. 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 .__lY�_�z �,�-- - � �1�- =-----Cr;�-EEK------ RIN.F --CENSUS TRACT __.�_'"S�_...-. r �. Owner's Name------ ------- 0 _0-ROENSO-&--------------------------------------------Phone ---=----------------------------•-•- t Address _A6293 -------------------- City ------[\-i-pp ----'----------------------------------- ---------- Contractor's -•-- -- Contractor's Name ---l.uE-�------00_I.VIV E-R S-------- --------------- --------License # ---------:-------------- Phone ------- -------------- ------- Installation will serve: Residence:eApar mt ent`House-❑ Commercial ❑Trailer Court i❑ Mo el ❑ Other ----- - ----------------------- j r� ,�} 17 4 - Number of living units:--- L_-__ Number of bedrooms _/_.__--_Garbage Grinder __�� Lot Size -� }A�V------------------------ l� / -------------- --------Private Water Supply: Public System and name -__��t______�_____�� .f� . � �� ❑ r Character of soil to a depth of 3 feet: Sdnd X Silt❑ Clay ❑ J Peat❑ Sandy Loam '❑ . Clay Loam ❑ a Hardpan ❑ 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 seepa it permitted'if,pu-licewq-r isyavailaGI_Ry 1i n -0 feet,} PACKAGE TREATMENT 'I.J: SEPTIC TANK'[ SizeY__,_... __� ... ___ __ _©: Liquid Depth _--_ ---------------- i -------- ----- 1j1 .r Y ` _ Ccapac�ty/.7_®-C=�_ ',fYpe.� f1 + Material__ �N 1rlo. ICom�iartments ------------� _. N Distance to nearest: Wellar '3��_ o______________Foundation _._.f�__ =v_�Prop- Li a _____ �p � i -.---- W LEACHING LINE [ ] No. of Lines _ ____3--__-__,_,_.. Length of each line-___ -------------- Total Length ___________________ ________ j Bo �_'5Type Filter Material __ 0_�-�Deptn Filter Material ----_. /�� � ,--- 1-------. Distance to nearest: Well __. ------------------ Foundation .__ f _=' ^---Property-Line -_.5:__""`I~`-.-_.. ` j SEEPAGE PIT k [ j;/1{ ..� Depth _ l-�.--._ -- Diameter_y�� Number __--_. [ -------------Y_____- Rock Filled Yes (No f❑ a t }Water Table Depth- -- - _ --=41Rock-Size-;1� _¢_ !1 Irl { '' i Foundation __l_ �_;:Mrop._ Line _____ Lf" Distance to nearest: Well --------:(:--�------------- �f -- ------- -TION IPrew Sanitation PermEt# --------------------------------------------°Date ----=---.----- ------------------) *� Septic Tank']Specify iRequirements) ___ 9 - c ___-70.--___ ------ Disposal Field fSpfYRequirements) tQ ..- -- r----- T t � � 1 - _ - _ . -- ---- -------------------------------------- -- ------------------------------ } ]Draw existing and required addition on reverse sideJ-_._, I hereby certQtNd I-Nave p�e_pared this._cIpplication,and-that the work will be done in accordance with San Joppquin County Ordinapce- Sfti-t e,.Laws---and Rules and Regulations of the San Joaquin Local Health District. Home owner or)icen- sed agents signdture certifies the following: "I certify -In,t e,performance of the work for.which this permit is issued, I shall not emploYe any person in-such manner as to b c e su k ect-t ` kman's COFrlpensati.an laws'of-California:"---~�----~- — ~ ' Signed --- --------- s t'�- f _ :.- Owner BYs .._.�.. 1_ Title _ --}`w-- --- - - ------------------------- ----------------------- , ` --- -.----�y (If oth�erE,than gwner) i . t , , , ry�";.�r tl tic F. r T!. a FOR .DEPARTMENT USE ONLY APPLICATION ACCEPTED BY -------- - ---- ------------- DATE BUILDlNG_PERMIT ISSUED —:_:_,._:_...-- ---------- : ::------------ : : _:.1 _.- .DATE ----------- --------- ADDITIONAL - ADDITIONAL COMMENTS ----- ---t---------------------------------- ----------------------------------------------------------- - - W -- ------- :_: -. r - -- --- ------------ - -- — ------------------------------ -- - - - - ----------------- ---- -----r ---------------- ------------------------ ---- - ---_ _ ____.__-__---_-_---_ - _ ---_ -__-_-_------_ ti -- •-----------------------------Date ------on Final Inspec / SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'6B Rev. 5M