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FOR OFFICE USE: � �•..�;, �` APPLICATION FOR SANITATION PERMIT I --- -..---- (Complete in Triplicate] Permit No. 0---1/ . --.__ This Permit Expires i Year From Date Issued Date Issued 70 i 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 Regulations: JOB ADDRESS/LOCATION . fF.D_ €f1x - :--..CENSUS TRACT ------------- Owner's Name - - <Il�137-----:5_27�_el-41�r?—!A/ Phone. =�L Address _ a'._,�O,Y--- 11 Cit cf'_E' 7� f Contractor's Name ----------- ---------------------------- - -------License # -- ------------ ------ Phone --------------------- Installation will serve: Residence ❑ Apartment House�❑ Commercial❑Trailer Court ;❑ Mote! ❑ Other -------- Number of living units:__;_._-__x-- Number of bedroomsXKJYA_Garbcge GrinderYe&- Lot Size Water Supply: Public System and name --------4/d IYf__-__--___ ----------------------------------------------------------Private ❑ Character of soil to a depth of 3 feet: Sand❑ Silt.❑ Clay ❑ Peat❑ Sandy Loam � Clay Loam [] t � t Hardpan ❑ Adobe ❑ Fill Mateyrial ------------ If yes, type ____________________________ (Plat plan, showing size of lot, 1 4cation 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 " t Ca ac SEPTI TANK SiSize- --------------- ----- ----- - ------ ----- Liquid Depth ------ --- { P tY YPe �� enial-__. _- No. Compartments Distance fio nearest- Well ---6i� �----------------Foundation --------- � -- .Prop. Line ---------------------- a LEACHING LINE No. of Lines IU�-------------- Length of each line/& -' Total Length r 'D' Box ----------- Type Filter Material epth Fi Material ,-_ -,rT-------- jr ----------•------•--- Distance4to nearest: We11. F-_-_______ Foundationt�} "� Property Line SEEPAGE PIT [ ) Depth Diameter-- Number ---.--------------------- -- Rock Filled Yes ❑ No i❑ a Water Table Depth---------------------------------------------------Rock Size f J. 'Distance"to-nearest Wel! ------5 --_____----- ---------------I-Foundation __.---._._ - i h ---- Prop. Line -------- •-..----- REPAIR/ADDITION(Prev. Sanitation Permit# --_____-----3------------------------------ Date ----------------------------------) f 114 Septic Tank (Specify Requirements) : _______________ - ____________ --------------------------------------------------- vt" � Dis osal Field (Specify Requiremencs) -----------------------T-- • _- ----±---- --------------- ------------ x ---- F:--•• , ------------------------------------------ ------------------------------------------------------------------------------------------------ ---------------------------------------------- QDr ----------- _ - - - QDraw existing and required addition on reverse side) I hereby certify that I have prepared this application and that the work will be clone in accordance with San Joaquin County Ordinances, State Laws, 6n'd Rules and Regulations of the San Joaquin Local Health District. Home owner or licen- sed agents signature certifies the following: -N "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 subject to Workman's!Compensation laws of California." Signed -- ` _ __� � r/� -;,511G`� C1 '/F1.4 / -rte' Owner C � BY ------- ---------� Title (If other wfan owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY DATE Z ._ f BUILDING PERMIT ISSUED _-__.__._ i ---------------------------------------- i ADDI TONAL CO MENTS : ------------ DATE ------ t --- - -...qtr-..+mss-- - - - --- - ---- - t�' - ---- -- --•--------- !V� -_ _ __ .._ _ ._ __ __ ._ _-___ _ _ _ Final Inspection by: - ------------------------- ------------------ ----------- ------------Date --- �-��-------- _ SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'b8 Rev. 5M