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FOR OFFICE USE: ....... APPLICATION FOR SANITATION PERMIT Permit Na. 70 -50/0 ' (Complete in Triplicate) ........ - ----- ...... This Permit Expires 1 Year From Date Issued Date issued 7-.91-_70 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. 54499�and existing Rules and Regulations: JOB ADDRESS/LOCAC�TT'IOQQN _� --- -- -------- -- ----- - - --__- -- ---.----- -- .Mom...CENSUS TRACT ------------------------- Owner's Name .... / 1" r 'J------• -•----------- --- --------- ..Phone--------------------••------------ Address9 f i---, j 7 ' . `Q-.. f1 fQ �(jQ��,--�.• ciy - //Oppp Ga.1----------------------------------------- Contractor's Name --------- ... --- -------/--=`-..!M.rcLa...License# /-G0.. 6-Y_ Phone ---------- Installation will serve: Residence Apartment House❑ Commercial❑Trailer Court ❑ Motel ❑Other _J -- --------------•- Number of living units:- ----- Number of bedrooms ry---.---Garbage Grinder .......- .. Lot Size ----------------_ _____.__�.!_ Water Supply: Public System and name ---- .........----------------------------------------------Private L'I - Character of soil to a depth of 3 feet: Sand❑ Silt❑ Cl ❑ Peat❑ Sandy Loom Q Clay Loam Q ` Hardpan E] Adobe Zill Material .----------. If yes,type------ --------_----------- (PI'ot plan, showing size of lot, Iota ion'of system in relation to wells, buildings, etc.-must be placed on inverse side.) NEW INSTALLATION: INo septic tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK] JSize-----.------_____------_-----`.------ - Liquid Depth ---_•------_.-,_-_`, Capacity ------ -- Type ------------------- Material------_---------- -- No. Compartments Distance to nearest:.Well .........................___---..Foundation ------------- Prop. Lane -_----------- LEACHING LINE [ I No. of Lines -_ -_---__----.--_ Length of each line________ _______---------- Total Length ---------------__.__ 'D' Box ------------ Type Filter Material ........------------Depth Filter Material - ---------_---------- Distance to nearest: Well ....................:... Foundation------------------------- Property Une, i SEEPAGE PIT [ [ Depth ----r--------------- Diameter :..'.•Number'------------- Rode Filled Yes ❑ No 43 Water Table Depth -------------------------------------------Rock Size -----------------•------ Distance to nearest: Well ------------------------_--------------Foundation -----------_---- Prop. Line ._ REPAIR/ADDITION(Prev. Sanitation'Permit# __-........... ............... Date _....._......__.__ Septic Tank'(Specify Requirements) ----------------------------------------------------------------------•- ----------- Disposal. ---------Dispose( Field ISp ify Requirementsl'•----------•---------_------ ------------------------------------------------ ---- P-> '--- .. L%: r - 4 ' L L f ._3 3-�1!'2 S ------- � 9 -- 1 (Draw existing and required addition on reverse side) I hereby certify that I have! prepared tlris application and that the work will be done in accordance with Son "win County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District-Nome ewe or licca• scd agents signature certifies the following: "1 certify that in the performance of the work for wtsidn this permit is issued, 1 *hall act employ any Ver"M in sede warmer as to becomesubject to War n Co enation Tows of California." Signed ..-------- -----------'---� - ---- -- ---- --- -- --- ------- - Owner . (If other than owner) ' / FOR..DEPAIRMENT USE ONLY APPLICATION ACCEPTED BY e -7 - - ------- - -...................... ------------------------------ DATE ----7 _1 .75) - BUILDING PERMIT ISSUED --------------------------------------------•--- .------------------------------DATE-----------------------------•--- ADDITIONAL COMMENTS -_-----•-------------------- -------------------------------------------------------------- --------- ----- -------------------------•-•------------------------'.-._- ------------`-------------------- - -- --------- ---- -------------..----.----••--`----------------------------------------------------------- ---- Final Inspection by: - - -- --- - - -- Data- SAN Da - T1 - SAN JOAQUIN LOCAL HEALTH DISTRICT