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FOR C`FICE USF: "PLICATION FOR SANITATION PEP `T ----------- --- -... (Complete in Triplicate) 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 Reg lotions: ., JOB ADDRESS/LOCATION/ _30'7aX.,... ------t _DN.ETR R-Z-----_..._.--------------CENSUS TRACT _------------.......-... Owner's Name --- - /V N-- -- -----_---------------- - -------------7- ---- --Phone Address -.30--7-0-Lf-----41�F-- --L .NETKET=------------ --------. City ---!- -A K A LI- - - Contractor's Name -------49WNEF --- - ----------------------------------------------.License # -- - - --------- Phone ------------------- .......... Installation will serve: Residence B_X�Partment House-E] Commercial []Trailer Court I❑ Motel ❑Other ------------- --------- -- ------------ Number of living units: --- Number of bedrooms Z__Garbage Grinder .No--- Lot Size _..ACIi A.E3 ........ Water Supply: Public System and name ....._ _ __....__ ❑ ,�� --------------------------------------------.._._.__._Private El ❑ ❑ Character of soil to a depth of 3 feet: Sand Silt Cloy ❑ Sandy Loam ❑ Clay Loam r[d� Hardpan Adobe ❑ Fill Material ------------ If yes,type -----:..s_.:------------ (Plot _..____(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 sewer is available within 200 feet,) PACKAGE TREATMENT [ ) - s ..._...._..__--_ Liquid Depth [ ] SEPTIC TANK Size.._.:_...__a_.._._._.___ __ Capacity ---------- TYpe -----------=-----'Material-------------------- No. Compartments ------------------ i Distance to nearest: Well ----------------------------------- ------------ Prop. Line LEACHING LINE [ ] No. of Lines ------------- ---------- Length of eoch..line-_.,._, ------------_.__ Total Length 'D' Box Type Filter Material .___.____.__.___Depth Filter Material Distance'to nearest: Well ----------------- ------ Foundation ------------ --------_- Property Line _.____..__------- SEEPAGE PIT [ ] Depth -------------------- Diameter --- ...._---.. Number ..._...______--Z,-_:----- Rock Filled, Yes ❑ No ❑ t h Water Table Depth ----------------------------------------------Rock Size------------------------------- 1. Distance to nearest: Well .__------_._----- ----__._.._..._Foundation ---------------------- Prop. Line ---__.__------._._. p REPAIR/ADDITION(Prev. Sanitation Permit# --------------------------------- .. Date --------------------------- V .. _ _.__ 1 f _ Septic Tank (Specify Requirements) -_,-----------------------------------------------------��11 ,_., ---------------------- - - ------- -- - - - I\' Disposal Field (Specify Requirements) ----- DV? .. , X AX---- .. - _ t e------------------ ------- ---------------------------- -----`-------`---------------- (Drawexisting 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 County Ordinances, State Laws, and Rules and Reguldtions 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 sub[e to Workma Com a satio ws of California." Signed _Y1114-- --- - - -- - _ - ------------ Owner By - - -- --- ------- ----------- ------------------- 7R-f?-.Title ------- - - --- --- ---- (If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY -1 R� - - _ - - -- -------------- ..------------ ------ ---------. DATE . I�.� --ki - - _--1 - BUILDING PERMIT ISSUED ---- - -------- ----------------------------- -------DATE ------ - - --- ---- ADDITIONAL COMMENTS ----- -- - -- - :------------ ---------- ---- ------------------- ------------------- --------------- - -- --- :-----7-P - - - ----.. ------------- -csr Final Inspec_ti_ b .:_. _ -- _... .. _ ..Date — SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M