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'FOR*OFFICeUSE: G APPLICATION FOR SANITATION PERMIT a (Complete'Tn Triplicate) Permit No. -.- - This Permit Expires 1 Year From Date Issued Date Issued 3 Z- -:---7 L Application is hereby made to the San Joaquin Local Health District for q permit to construct and install th'work herein described. This application:i ,made in compliance with County Ordinance No. 549 and existing Rules and Regulations: 3 JOB ADDRESSjLUCATI�N PU- A _ 0Q t� - oo- B�Ys [U._-.- 39 ---- -CI=NSUS TRACT -------------------------- P._ { L._C�_11A.1- Owner's Name _�.� --------- • ---------- ------Phone -- --- ------------------ •--------- Address _ - --------------------------------------------------- City --DPO -,-ANT---- ------C--- -_1rA_LI-F---------------- Contractor's Name --------------!J L�F ' R� - - - ---------------------------------------------------------License ----------- Phone-4-15,:311-3,356 Installation will serve: . Residence;KApartment House�❑ Commerciale❑Trailer Court ;❑ I Motel E-1 Other -------------------------------------------- 6 ------------ ------------------------- Number of living units:__.-.-____- Number of bedrooms _�--_-_Garba Garbage -�D---_ Lot Size g. + C)-I�LrQ _Csw-¢FYI P� • r .: r Water Supply: Public System and name ----- -+�- _-�W-ate..-q-} g ��gp. ------ 7;? JSJA-,,, Private ❑ Character of soil to.a depth of 3 feet: Sand'❑ Silt❑ Clay'D3.- Peat 2! Sandy Loam ❑ Clay Loam ❑ i 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 seepage pit permitted if public,seuier is available within 200 feet,) ' PACKAGE TREATMENT SEPTIC JTANK>< Size----------- _ --------------�j ` _�f�--------- - Liquid Depth ------------------------ Capacity --- ------.-_-.-.-.- Ca acitYtype Matenai No. Compartments ---?�--..... I Distance to nearest: Well ---------------- --_---_.Foundation -------- - _ Prop. Line .s��_ . LEACHING LINE; No..of Lines k 4 e� r o ----=--------- Length of each.,line---i��------------------- Total Length -.(c_G.-- -----• I D' Box __--�..---__ Type Filter Material � --&_j_- Depth Filter Material _--_v2-___ Distance to nearest: Well ---------------------- -Foundation ------------------------ Property Line ---------------- ' SEEPAGE PIT [ j Depth r_-___�-__------_--- Diameter -__-__- ---. Number _-------------- < .--______ Rock Filled Yes Q No 'Q • r � �. Water Table•,Depth -------- --------------------------------------Rock Size -------------------------------- I Distance to nearest: Well ----------------------------------------Foundation ---------------.---- Prop. Line -------------- ------- "fl- N(Prev. Sanitation Permit# .. ---- ----------------------------------- Date �-------------------------------} 1 J _Septic Tank (Specify Requirements) �y -----------------------------------------------•.-•----------- A ` f-------------�--------------------- -- iD ------------- Disposal yF�i'eld {Specify RAgiLj,rd --=�---�-�z�L---•------1 -�j�-------��_ --------let_ M---I _1��--- ilo 1).14 --- ----- ------- ---- - ,__,,_4(Dra.w existing and required addition on reverse side) I hereby certify that 1 have prepared this application and that the work will. be done in accordance with San Joaquin County Ordinances, State laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner or licen- sed agents signature certifies the following: "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 su�t to Workman's Compensation laws of California." Signed ul/- `U-`' € _ -------------- `---------------------------- Owner BY ��' '— `�---- ------- ------- ----=-------- —----=-------------------- Title ------ ---- other than owner) --FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ------ -- -- ------ --- -- - / --- ---- ------ ----------. DATE BUILDING PERMIT ISSUED DATE ADDITIONAL COMMENTS ---------------i .- ------- -- - ------------------------------------------------------------------------------------------------------------- ----------------------------------------------------------- --- --- ------------------------------------------------------------------ ---------------------- - - ------- t-- - --------------------------------------`-------------------- ----------------------------------- Final Inspection by: ------ --- -=� ------------Date --- --------- SAN SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'6$ Rev. 5M ..