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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT a Permit No. ...x�.�.9:�/. . _. . _. . ...___._..... ...............__. . {Complete in Triplicate) ... ._..._ .................................. v^ P Date Issued ...9�7:-�L. ....... `This Permit Expires l Year From Date issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and Instali the work {Nein described. This application is made in compliance with County O inonce No. 549 and existing Rules and Regvlaticutsr . ...............__CENSUS TRACT ..... `. JOB ADDRESSAOCATION ...I.0. :24 ....-. ............ .. ti. .Phone ....T JV: ! .TO/ Owner's Name .... . s Ci7 !................ ........ o . . Address ../_o..-.'z.6 0. _... a �L................... *Y .... _ 6aT ��+ig Contractors Name .. - -- "' "" License# .0.1,947 a l.. Phone . . installation will serve: Residence Apartment House❑ Commercial❑Trailer Court ❑J Motel❑Other........................................... / .( �,�/--••cwt. /..._.. .. Number of living units:-_(...-... Number of bedrooms .,T- ....Garbage Grinder ._......... Lot Size ... - - Water Supply: Public System and name . .............................................------ .................................................Private AD "I Chorocter of soil to a depth of 3 feet: Sand${ Silt❑ Clay ❑ Peat❑ Sandy Loom ❑ Cloy Loam❑ Hardpan❑ Adobe❑ Fill Material............If yes,type............................ .t IPlot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) O NEW INSTALLATION: iNo septic fork or seepage pit permitted if public se/i�available within 200 feet) N PACKAGE TREATMENT { ] SEPTIC TANK,t(j Size... -�X- 4•06... .r.�..... - Liquid Depth .......f/40......._. % � � ` I ' Capacity /6Do....... Type ....,p,�, MateriaL.terr.VT�su No. Comportments ........��.,•-_-•- D ,..... ...• �D } Distance to nearest: Well o..'�..-.G/...1..".-Foundation ....�d�...... Prop. Line.....��.-•--• LEACHING LINE I(J No. of Lines ._.....f............ Length of each line_..LD.2..... .._.. Total Length ....4wla............. jl - 'D' Box .... ..-._. T Filter Material .'Z- pth Filter Material t!--Q ' / Pro Line .co........ Distance to nearest: Well .-...Q�......... Foundation -.....n Property •• ••••• SEEPAGE PIT { ] p •-•---... .......................... Rock Filled Yes No 0 De ih. ................... Diameter Numoe• . ❑ WaterTable Depth ................................................Rock Size ................................ Distance to nearest: Weil ..................................... Foundation .................... Prop. Line ........ I '. REPAIR/ADDITIONlP:ev. Sanitation Permit#........ .... ............................. Date ............ ................... �O Septic Tank (Specify Requirements) ..... ................................................ ................ ..............................._............._................ Disposal Field (Specify Requirements) ..... .. /irw.s�s!�'-�. ..................I................... ......._ _..._.. ................._......_._.. _.................. /Q...f.J.... ..•• .... .............._...................... -- ..-......... (Draw existing and required addition on reverse s de I hereby certify that I have Prepared this application and that the work will be dine in accordance with son Joaquin County Ordinances, State Laws, and Rules and Regulations of the San Jaaquin Local Health District.Home owner or flours• sed agents signature certifies the following: •'t certify that In the perfermon:e of the work for which this permit is issued, I shell not employ any person in such manner as to become subject to Workman's Compensation laws of California." Signed . ... .. _ ._. . ._ ..............0................. .. Owner .`?Fay'—Y�C �AC......_..... . . Title (If other than owner) FOR DEPARTMENT USE ONLY t� APPLICATION ACCEPTED BY . . ... __. . . .. _. ....._.. DATE /...✓.?... 'y.. . . BUILDING PERMIT ISSUED .. .__. _.. ............... ..... . .. ..._.... . ........__..DATE . _._._........................... . ADDITIONALCOMMENTS .. . . ._ ..... ....__...__..........._..__... ..._.. ... ._..__ _. _.._... ....._...................... .._ .. _._ ....... . .......................... Final Inspection by: .- Q . .. .. ....... .. .,._ .. .Date 17 SAN JOAOUIN LOCAL HEALTH DISTRICT E.H.9 1=68 Rev. 5M