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FOR OFFICE USE: _ ] APPLICATION FOR SANITATION PERMIT .. 4f, � (Complete in Triplleaft ...4....! Permit No. ..9._..r `. j+ .............................:.........................� This Permit Expires 1 Year From Daft issued Date Issued....L....."...� Application is hereby made to the Su• >aquin Local Health District'fora permit to'consttuct an Install the work herein desoibed. This application is made I _umplfance with County Ordinance No. 549 and a*fisting Rules and Regulations. JOB ADDRESS/LOCATION ... L_7...... :...._�14:00 T.h.E .. . .(, ,A,(,. 5115 TRACT .... .:..........._... t Owner's Name ........ ..1.��/a.t`4........6 . I.FFL.!.V._:......................................__............ ..........Phone...$Y7...Q 7.kt...... i...';. . Address . Q7.U.r�...... ......L.QI11.t..TKr..........8.0......................City..01A.I PA.47..........._.........e.. ..................._. § Contractor*-.Name...1�L.V./J.�.F ........ ..::.......... ...License# ........................ Phone .....'L.. + Installation will serve: Residence ETApartment House Commercial [-)Trailer Court ❑ ' e Motel ❑Other'....q........... Number of living units,...1...... Number of bedrooms .!—' ....Garbage Grinder ......Garbe a Lot Size ..t4.CRER.6. ..L:.. - i - Water Supply: Publie System and name .........................L........_. .Private❑ ............................. ' Character of soil to a depth of Veat: Sand 0, -Silt❑ Clay ❑ Peat❑ Sandy Loam�O Clay Loam 0' j i '. 'Hordpdn[,Adobe❑ Fill Materiel /0.:..,if yes,type............................ .mak 1 i ) (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 peemitted;if,public sewer is available within 200 feet,) W i PACKAGE TREATMENT [ I SEPTIC TANK T J .................. ..... . .... . . .... Liquid Depth .......................... i t ; Capacity.................... Type ....................:/Material...................... No. Compartments ...................... v ` Distant* to nearest, Well . . .... Foundation.. ................... Prop. Line...................... O K' > LEACHING LINE [ ] No, of Lines .. ... ........... .... Length of each line.. S)........... ... Total Length ............................ f �S 'D' Box ..... . . Type Filter Material .?...:.......... Depth Filter Material ............................................ sDistance to nearest. Well .........................Foundation ........................ Property Line ........................ SEEPAGE PIT [ J Depth Diameter ............... Number ............................ Rock Fillad Yes ❑ No Q Water Table Deoth .................... .......:..................Rock Size................ .............. Distance to nearest: Well .......... . ...........................Foundation ................... Prop. Line ............ REPAIR/ADDITION(Prev. Sonitalion Per mita.............. .. . .. Date .............. . ................) Septic Tank (Specify Requirements) . .... _.. . .......... ..... .... .. ........................ Disposal Field (Specify Requiroments) ....... EP.Tr,C,..._..VAA/X S.....ILWLT<`�.......... 1.ZOiJ.....GA4: ...- .COP)OA1wTiE......TANK......-......DL.'ii.£. LOX. r....€Qvtcli.....Q/ '::..._ �S1.ST/.�I . 4. .R_GN.I-l.!�E (Draw existing and required addition on reverse side) I hereby certify that l have prepared this application and that the work will be done.in accordance with Son Joaquin County Ordinances, State Lows, and Rules and Regulations of the San Joaquin Local Health District.Home owner or liceno ";J. sad agents signature cerliffes the following: - I "I certify that in the performance of the work for which this permit is Issued, I shot' not employ any person In such manner as to become subject to Workman's Compensation laws of California.,, Signed .. ...._. ... . . _. Owner �^ aa �� J By "�v"...nr1l'GL't'1. ✓� t.V1, ... Title .__ (if other th o'vne --- --- FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY T.L n _.. .... .. DATE I/.,.�..`..Fi . . ........ BUILDING PERMIT ISSUED _ .DATE ADDITIONAL COMMENTS - - " """ Final Inspection by., 6��I; , , ... // , �/ �.. JZ.. -, Date ZZ i SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1/6E Rev. 5M