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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT � .................. P Permit No: .. ..................... ... ......'_. (complete in Triplicate) 1 ...... ---- --- --------- � Date Issued 1 ' 0 This Permit Expires 1 Year From Dais Issued [ ._._.. rc Application is-iii'reby'made to the San Joaquin Local Health District for a permit to construct and Install the work herein i described.This application is_maadee in compliance with County Ordinance No. 549 and existing Rules and Regulations: E JOB ADDRESS/LOCATION .... /J L 2 '.. e— •_N W .---- CENSUS TRACT _ - ...-- MiaA�---- ..,�7.1.K. .F -�...- _....-------... ------ •---'_..... ---.....Phone •• .....- - ... • ----------------- Owner's Name r ,. Address ....... . . T,; ...__.IIQA_rlTE:c14 .. 1�JSQ----- --�-__..taw, .---.;.1...�•:Q.:.........:..ci Contractor's Name ..©jjjii 19.*EP�l. ...---- --................. ............. •....License # _........ ---- ....... Phone -----------•----------------- L' Installation will serve: f Residence ortmeni ouse0 Commercial 10Uailei Court ❑ it (1i^:7AC Mcitel []-other L _... -- ..............I-------- I In+._t J'' tug /2--. arbage Grinde �^� Lot Size .XXC�1 CYt= •••••-i Number of living units:-..__�... Number of ve rooms . � e � --------- ----------------:._.......... I .....s-'�-- ......----....•.... :Private —_tea Water Supply: Public System and name ._---_----_-_-_:_.[ - 1 Character of soil too depth of 3 feet: Sand❑/Sllt❑ Clay ❑ 'Peat�j (�Sandy Loom Clay Loam ,,0 HardpSn❑ Adobe C] Fill Mcferiol .(.X. -- If yes,type .-..'-------- --- \ r i v V r . :jPotplan, showing siie of lot, locotion of system in relation to wells, buildings, etcmust be placed on revere side.} Er W INSTALLATION: lNo septic Tank or seepage p t permitted if public sewer is avatiable with'n 200 feet,) PACKAGE TREATMENT [ I SF+TICTANK'[ ] Size.:........I...............�-'........... Liquid Depth ..._-.......--__-.----_-- JCapacity _........:.. Type Material--------- ----------- N Compartments ---------..._..... Distance to nearest, Well ..........................Foundation ..._.... - Prop. Line..._....._...:.,....__ ' .... Total ,Length Length of each lino...:....�' - LEACHING LINE [ ] ��----� �� -' I No. o Lines ............. ------ I ' BOX ............ Type Filter aterial ............:......Depths Filter Mat rial .-�------..-..............----------- 'D'( Distance to nearest: Well FouhdaTion -��-.-•------ - - Property Line ................... .. SEEPAGE PIT [ I Depth '�................... Diome r ____----------- Number ------1':.-.------------ .. Rock Filled Yes ❑ No .� i w Water Table Depth ...... .... ................................... Size ...... .... .------z.... Distance to nearest: Well . . . .............. .._......_. ....Foundation ----- ..........vProp. Line ...................... t _ Ni REPAIR/ADDITION(Prev. Sanitation Peimit!N.._.,-.,; ^• DatF-------------- ---------- .Septic Tank (Specify Requirements) -----------___//-��................. Vatic Disposal Field (Specify Requirements) ......77�r�- -.---.•.j ... -- H"-" '�' ��"- '---- •---• .�F -A........ - ' ... J __------------- ___ -- - i (Draw existing and required addition on reverse side) I hereby certify thut'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 Locat l Health District. Home owner or licen- sed agents signature certifiei46 following: "I cerN in the perlo c of the work for which this panni(Is issued, I shall not employ any person In such manner as to bec subject T W rn 's Compensation laws of California.". Signed/ ` --------•-------------------_ Owner 1 By - - - .................... ------ Title ...... ..::.-------- -- ------------------_. ........ , (if other than owner) _ •. FOR DEPARTMENT USE ONLY ' 1 APPLICATION ACCEPTED BY [ - U- - DATDATE .....__. i BUILDING-PERMIT—ISSUEDi :_, :J LBI, kk' 5 ADDITIONAL COMMENTS ... - i ... ........._ ................ � - -- - 1. � .... •------------------:......... . ata Finai inapeCtf - - •• -- - - >� � . .. . . / SAN JOAQUIN LOCAL HEALTHA?lSTRICTF - E.H.9, i•'68Rev. 5M