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. . FOR OFFICE USE:. APPILICATION FOR SANITATION: PERMIT (Complete in Triplicate) Permit No. _ `r______________ ------------------ bate Issued .__6_� 7 ' _-------_-__.____._--___________:_-_______________ This Permit Expires 1 Year From Date Issued FApplication is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein FF described. This application is made , in compliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION r._.__!�NN�__�_1__�t' 'l -----z C -_-- Q -------------------- --- CENSUS TRACT --------------•---------- Owner's Name C(mN-- -A- -II:- O--------------------------------------------------------- -------Phone ------------------------------------ Address -------------------- --- 961-----N,----Wfu-7-nec_�------------------------------ Cit, ------------------------------------------•-------•-- Contractor's Name ------ -o3ilY�.--�L�b Y----------------------------------------License # _`9_2_5:SPS Phone _��t �r��e�------•- + Installation will serve: Residence ❑ Apartment House❑ Commercial ❑Trailer Court ❑ Motel 2-CSther __ �ri - -•-------------- F Number of living units_____________ Number of bedrooms ------------Garbage Grinder ------------ Lot Size _.________-_---__--____________-_-__.__-__ Water Supply: Public System and name --------------------------•--------------------------------- --------_.--------------------------------------Private ❑ Character of soil to a depth of 3 feet. Sand❑ Silt fl Clay ❑ Peat❑ Sandy Loam ❑ Gay Loam Hardpan ❑ Adobe [Fill Material ------------ If yes, type -------------------------- (PI'ot 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 sewer is available within 200 feet,! PACKAGE TREATMENT SEPTIC TANK l { ] - -- �� Size---- -- ---��----------------------- Liquid .Depth -�-�------------- i . Capacity _ �90 T _ _S __ r_ yp -Com "___ Material.C.'6 ___ No. Compartments ____da�___._______. I Distance to nearest: Well ---------�4--------------------Foundation -----10------------ Prop. Line ---IA`s- :---_----� LEACHING LINE [ ] No. of Lines -------- Length of each line------`iC ________________ Total Length -------qC3_-_____-__-____ t 'D' Box - __ -- Type Filter Material _ ' ' -��----•--De Depth Filter Material ----------�'�-`---------------------•------� Distance to nearest: Well -----7S ��------------- Property Line - -------- Foundation ----- = ��r--------- SEEPAGE PIT [ ] Depth ____________________ Diameter ---------------- Number ---------------------------- Rock Filled Yes No .Cj' Water Table Depth. ---------------------------------------;--------Rock Size -------------------------------- Distance -------------------Distance to nearest: Well ----------------------------------------Foundation --------------_.---- Prop. Line -------._---.:-_.----- y f REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date -----------___-------------------_} rSeptic Tank (Specify Requirements) -----------------------------------•--------- - ------------------------------------------------- --------.-,..------------------•-------- � ' Disposal Field (Specify Requirements) ---------------------------------------------------------------------------------- ---- -------------------------- ----- -- ----------------------------------- -----------=------------------------ (Draw existing--a---n-drequired 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 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: t "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 bet �subjectto rkma Co pensatolaws of California." Signed,LE_ -- Owner j -- - BY ----------------------------------------- Title ----------------------------------- - - ---------- ------------------------------------ (If other than owner) ! I FOR DEPARTMENT USE O—lAY APPLICATION ACCEPTED BY - = ------ ` . DATE ---- t - --------------- BUILDING PERMIT ISSUED ------------ -DATE F ADDITIONAL COMMENTS ------------------------------------------------------------------------- --------------------------------=------------------ 3 _____________________________________________________________________________________________________________________________________________ ____________________________________________________________ ` ________________________________________________________________________________________________________________________________________________________________________________________________________ i 1 _ / Final Inspection 6 Date _ fa �• _-�- SAN JOAQUIN LOCAL HEALTH DISTRICT