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FOR OFFICE USE: .� FOR OFFICE USE: t APPLICATION FOR SANITATION PERMIT ---------------- q .� ;� (CcMplete in�Triplicate}- Permit No., �._.G_`�_r ----------- - ---------- ---------- ---------------- - Date Issued---_... ------------ --------- ---------------------------------- This Permit Expires 1 Year From Date Issued 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/LOCATIO # _ • ? ---- - C.�._.e� CENSUS TRACT-------------- ------------- ---=----•-_--;------'•_- Owner's Name------ k ; . �-av� :. . . ----- -- Address._-- ---- ------ -- Phone -- _ iL i. ' ---- ----------------- _--- �. - � ------ ZAP --------- --- Contractor's Name___ --------- -__ License #_ _ a Phone-_ S _,Z,Clep Installation will serve: t Residence Apartment House [] Commercial ❑ Trailer Court ❑ �. . Motel'❑ Other ----------------------- ,1 1 Number of living units:----- ------Number.of.bedrooms'___ __Garbage Grinder_._'__.___-__ ot Size--___-a.____ ' ----------------- -------------- Water Supply: Public System and name------__.__.____;_------------ _ _ - P ' -- --- -------------•----- ---------=.------------------- -------- _-- ate, riv Character of soil to a depth of 3 feet: Sand ❑ .Silt❑ .Clay ❑ Peat ❑ Sandy Loam ❑ 'Clay Loam i Y Hardpan L Adobe,Lj Fill Material ..______. If yes, type-- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) NEW INSTALLATION: .• .....-!... ._.H_, :'.,_ ._ .: F " (No.�septic tank'"or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ ]� ,SEPTIC TANK [ °' Siz 7 ----------- --------------------Liquid Depth-___ :_ __.1{ C cit �, P = : P Y- -An0- Ty - �--- : _Matarial----:- ---� - --._Na. Com artments_-.--------_ yf --------------------- -to ------------- - Distance to-nearest: (Nell.:_::__, [ ._-_,__ =-------------;_..__ Foundation_.) _..,____--- Pro Line_ - _- -,---_- t s � � P LEACHING LINE `�� 3 ` ["T n1o`.:of Lines------ ;- :-- =-Length of eachh line,__�S-,. / _Total Length ------1.76-----------_'---1-"--- D' Box-.__ ---a'__Type Filter Matlrial_� r_ . LT [JDepth Filter Material_.___ _ -------------------- � ___Foundatini' �___Property Line_..__ ----- --------------Distanceto nearest: Well_ : SEEPAGE PIT [LK Depth___ ---Diameter.-_- `J� -------Number--------- '� ---------- ��`-(} r Rock Filled Yes No - Water Table Depth-------- ----.----.Rock Size----- ,,�----------- -_---------"----- _____Foundafion__'_ J - -- - Pro Line_ T Distance to nearest:Well �. __ __ P J = ` - i _ - -.--- -_ REPAIR/ADDITION [Prev. Sanitation Permit# Septic Tank {Specify Requirements)_ t l f ------- a e --- - ---= -- Disposal-Field (Specify Requirements)_- .......-------- --------:--I-- - ti-�,, ------------- ----- ' -. ------- - ------- --- - --- ---- ___ ___ `�'``" "`""'(Draw, existing an required adaition on reverse 'side) 1 hereby certify that-I have prepared this,application and that the work will be done-in r accordance with San Joaquin County tY Ordinances, State Laws, and Rules and Regulations of the San Joaquin local Health District. Home owner or licensed agents signature certifies the following: "1 certify that"in the performance of`the work for whicFi"this permit is issued, I shall not employ any person in such manner"as , to become Iec to.W rlEma ompensation .laws of California." Signed ----- t-_-- ------------------ F---------'------ - -- - _ BY- = Cpm " Titl ------ Owner a a (I.f other than.owner) # 'F94 DEPARTMENT USE ONLY x d j APPLICATION ACCEPTED BY--- ------ ---- -- ------------------------------------------ -----------DATE.------ -- --J-----7--------------- DIVISION OF LAND NUMBER. --------- -- ----------t�-------,--------------- ---------------- DATE ------------- - --------- - ADDITIONAL COMMENTS___________________________________ ------------------ - -- --- ---- --------- -.------------------------------------- -------=-------- -------------------- ------------ J . _______ ______ ________ _____-------------------------------------- ------- ---------------------------------_----------- - - Date'- EH = - Final Inspection-by: f � ----- --- --.'3 24 AAQUINLOCAL HEALTH DISTRICT F s 21677 37i6 3 /+ ✓ ��