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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT 3 Permit No. ------ -- --- -------------------------- -------------------------- (Complete in Triplicate) = -------------------------------- Date Issued q. 70 .,This Permit Expires 1 Year From Date Issued - _ _ ____- -------- ---- Application is hereby made to the San Joaquin Local Health District for a per to construct and install the work herein I described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: i JOB ADDRESS/LOCATION e � ' f� `---- ---------CENSUS TRACT -_ {�--�.-r-------- Owner's Name -----I� /� ---�X'6.#V/AV6ae. l - Phone "= C-L Address ---- �- _ P - .>_ -------- City 17reb—Al------------------------------ ---------- •----•----•- Contractors Name ---- X ------------------------------------------------PAV— ,/; -------.License # - Phone ? 1 ' �~ Installation will serve: Residence 5Kartment House❑ Commercial ❑Trailer Court ',❑ Motel ❑ Other ------------------------------------------- Number of living units---- Number of bedrooms _:_ -----Garbage Grinder `.___-- -__---Lot Size -- -_-- - - - � --'� ' --------------•---- Private ( � Water Supply: Public System and name ---------------------------------•----------------------------------- lee Peat Sand Loam Clay Loam ❑ Character of soil to a depth of 3 feet' Sand'�ilt❑ Clay .❑ ❑ Y ❑ Hardpan ❑ Adobe'❑ Fill Material ------------ If yes,type ----------------------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc, must be placed orimeverse side.) septic tank or see age pit permitted if public sewer is available within 2D0 feefi,j NEW INSTALLATION: (No p P -. PACKAGE TREATMENT [ ] SEPTIC --------------------- --------- Liquid_Depth - --------------- Ca acit 1 I Material------------ - --- No. Compartments ------ .............. Pyi;-!-------- -------- Type -:----------------- - i Distance to nearest. WellJ---------------------------------Foundation:__,SL�- =L--- Prop. Line -------------=-------- Na. of Lines of each line--------------- 'D' r- ----_-- --- Total Length -----------------•-------- LEACHING LINE [ l ------------------------' t Filter Material --------------------------------------------V Box '___--___--- Type Filter Material -_--___�_--_._--.Depth lFoundation Property Line -------------•-•--- Distance to�nearest: Well .... Foundation_ _ .----- _ SEEPAGE PIT [ ] Depth ---- DiametJ- Number -------------;-------------- Rock Filled Yes ❑ No 0 : IRock Size ------------------------------ Water Table De #h--- --------------------------------------------- i - . Q _ Foundation ---------------- Prop. Line -------- ------•---•-- Distance �0 7 ------------------------------ r REPAIR./ADDITION(Prev. Sanitation Pe mt#Well _ ----� ---------------------------- Date _-------- ------------------------ ---------------. ------------------------- - Septic Tank (Specify Requirements) `-- --- - ----- `" i E Q e 1 - 1 ----Awklp---------- I Disposal Field (Specify. Requirements) I � ��"DID '��w - _-- --------------------- 7 .Fr --w ,tr�---------------------- ---- n --- -47*411171 H (Drawexisting and required addition on reverse side) I hereby terrify,' hat I hatie prepared thW,application and that the work will be done in accordance with Safi Joaquin County Ordinans, State Laws, and Rules and Regulations of the. San Joaquin Local Health District. Home owner or licen- sed agents signature certifies the following: such°manriep y ` "I certify`th''at rin the performance of the work for which this permit is issued, I shall not employ any person-in, . � as to becdm'e�uljlect ,to Workman's Comp.ensation laws of California." r Signedr`r -------- Owner t. z' t - Title . cliq+�tti By -------- ' ------ - .A �. 11-f btheraharl!i owner s a- FOR DEPAitTMENT USE ONLY r . APPLICATION<A CEPTEDBY --- - Q----------- ------------ ---------- ----------- ---------------------- DATE - - --`.�----7---- ----- BUILDINGPEIlT ISSUE 1--------------------------------------------' ---------------------------------- = DATE ------------------------------- l2NL ADDITIONAL�CaWMENTS---------5----------- `------------------------------------------•--------------------------------------- --- ------- ---------- ------- ------- --------- -------------------------- - - - --------------------- i t = Date ��. - - - ---- -- - : - ------ Final Inspec vre SAN JOAQUIN.LOCAL HEALTH DISTRICT n "' E"H. 9'•.""..1='68 Rev"5M