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FOR OFFICE ) APPLICATION FOR SANITATION PERMIT�- - ----.��'��- --�i.�' Permit No. (Complete in Triplicate) _. --------- `�'- - r .f ,w� �' Date Issued --------------------------------------- This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Hedlth District for a per to construct and install the work herein described. This application is made in co fiance with County Ordinance No. 549 and existing Rules and Regulations: Z 0 - ,�.�- JOB ADDRESS/LU ATION --------------------------- -_��- ..-- " ---------. �!.� CENSUS TRACT -------------------------- Owner's ---------------- -----=Owner's Name ----- -l�f, o-h' -�_�.�#?-------�- -----------------------------------------------------------Phone - -------16 6 o-_lE?, � l_�--------CS4_`------ --. City ,-- `f 7-=- ---- ---------- - Contractor's Name --- SP�ILZ--- -s- -r-.c (�G' ------------------License # +✓ -O .J-- -- Phone -------- -`"c ,�- 1--- Installation will serve: Residence Apartment House-E] Commercial ❑Trailer Court ;❑ Motel ❑ Other - ----------------------------- ------ Number of living units:----'------ Number o bedrooms _.__Gar age g rin ------------ Lot Lot Size 6----- ----------------------------------------- - / - PrivateWater Supply: Publics stem and name --- _ . J ❑ of soil to a depth of 3 feet: Sand'❑ ilt CI Clay ❑ ' Peat❑ Sandy Loam ❑ Clay Loam ❑ ° 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 Iside.) F NEW INSTALLATION: (No septic tank or seepage pit permitted if public sew`r,•s available within 200 feet,) «t Q PACKAGE TREATMENT { ] SEPTIC TANK Size_- ,2(1,RZ ----------- Liquid Depth :5?7-(;?----------- � Capacity IUD----„ Type -� � - -- Materialta O M_--.-- No. Compartments ----Z..:.......... E Distance to nearrr��est: Well +107!-�--------------- ----•Fouunyd .� ation -_-IQ-�- ------ Prop. Line ---- --___------ If LEACHING LINE )( No, of Line`s --- ----------- ----- Length of each line----<-s�--.------- -- Total Length 145_7_0... 'D' Box .A------- Type Filter Materia&fA',,_Rk__Depth Filter Material-__1q- -------- ----------------------- Di is an'ce to nearest: Well 11-0_tFL — Foundation /0!-------_------- Property Line --------- SEEPAGE PIT Depth ----. - ---____ Diameter _ _> ----- Number - -- -.--- -- Rock Filled Yes No Water. Table Depth ``- -------------- ----Rock Size ------- = --------- Distance to nearest:.Well:A N.S'-----------------------Foundation _--' Prop. Line _-_---_-__....._-____.. . Pk- XX REPAIR./ADDITION(Prev. Sanitation Permit�# --------------------------------- ' ---_ Date --------------.------------------- 77 / ------------ --- 3rd`.' / , : I Septic Tank (Specify Requirements) ------------------------- ,.t --- ::---;�-�`---- - .,. . ------- ' Disposal Field {Specify'Requirements) ----------- - ------------------------------------------------------------------------- ------- -------- ,4 . � �I-a,*- •♦� r— , r ------------------------------------------------------- (Draw existing and required addition on reverse side) I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin E 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 "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 bec a bject. to Wor an's C�-o-mmp-e tion laws of California." Signed _E_A_.R- 4 �� V � e.. L.- BY ------------------------ --- ---- ----------------- �'J��`�1" ------------ Title (If other than owners FOR DEPARTMENT USE ONLY , + + PI 1 APPLICATION ACCEPTED BY ---------- -- r��" `"` r'°"' ----------- DATE -- -------------------------- - BUILDINGPERMIT ISSUED ------------------------------------ ----------------------------------------------------- -------DATE ------------------------------------------- ADDITIONALCOMMENTS ------------------- ------------------------------------------------------------------------- ------------------------------------ ------------------------------------------------------- ----------------------------------------- --------- ---------- - -------- -- - ---- - ----- ------ Final Inspection by- ---------------------------------------------------------- Date � SAN JOAQUIN L AL ALTH DISTRICT E. H. 9 1-'6B Rev. 5M