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-FOR'OFFICE USE: I .. APPLICATION FOR SANITATION PERMIT - ------------------------------------- (Complete in Triplicate) Permit No. dee" r ;a r Ddte=l.s-sued _ -------------------------- -- This Permit Expires 1 Yiar From Date Issued �. '; / . Application is hereby made to the San Joaquin Local Health District for is permit to construct arid install the work herein described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations. JOB ADDRESS/LOCAs'IO.. N .--.. 49_2_1'w.9.7 -- jLAiq_ , NOwner's Name N . w Address =e----- t _ Ciy. 1-vl-I f YEC f ---'-A----°==y------•----------------- Contractor's Name I ,�(-Q/4 1 fr __`-.License # 252SQ_JPt►oFie Installation will serve: Residence['fApdrtment House'❑`Commercial:❑Trailer Court ❑'� I ; I - o el ❑ 11--Z--------------------------- r ^ l Motel � Other _________ Number of livin units:_-__.'____.�_ Number of bedrooms ._ _._'-,'-.Garbage Grinder _ Lot Size _Y67----x---1aV_______-___- Water Supply: Public System and name =�_�_____ �� - _ Private 0� - - -_ ------------- Character of soil toadepth of 3 feet: Sartd'� Silt.0 Clay ❑ -Peat.❑, Sandy-Loam ClayrCodm_� _t_-- k , j � Hardpan E) Adobe'❑ Fill MatericiPWO___ If yes, type ____________________________ (Plot plan, showing size of lot, location ,.of systemn relation to wells, buildings, etc. most be,placed on reverse side.) NEW INSTALLATION: (No septic tank or seepage�!pit permitted if public sewer is adaillble within 200 feet,] r �} PA&AGE'TREATNIENT { a 'SEPTICTANK;[� Size--- .X_1_�___ _ , __..._., -_ =F_ Liquid'Depth______51' __.----- V � L Capacity __lb-O--,-- Type PRS-FAQ_ Material-�NC!n t .No. ,Compartments ____2-- ......... -fi. - \ Distance to nearest:' Well :' --- --------=-----t__ __Fouaclation -'1+ , ..` ___'._ Prop. Line ____J�------------- --------------------- LEACHING ___._... __ II LEACHING LINE [er"" No. ,of Lines ---------2-_____ Length of each line-------7��__-__------ Total ;Length rr 'D' Box /Vf0ES'_ Type Filter Material _RO_5� ____Depth Filter Material --------/Y . 1 Distance to nearest: Well ----, 0--------.... Foundation—_,/D_4____-_.___ Property Line ____5_______________ , SEEPAGE PIT [ ] [ Depth_____ -_ -.-_�,-Diameter ------ .--..----.Number -------- ------------------- Rock Filled Yes C) No 0 Water Table Depth - -------------------Rock Size ------------ ------------------- Distance to nearest: Well ------------------------------------------Foundation ---------------------- Prop: Line REPAIR/ADDITION(Prey. Sanitation Permit# ________ ----------------------------------- - Date - ------------------------------- Septic Tank (Specify Requirements) ------------------- -------- ---- ---------------------- ----------------------------------- -- ------- -�-------------------- Disposal -- ------- Disposal Field (Specify Requirements) -A13AIV.Dmie_f7------- I D- PR6o_gF_-----FiNA-L-----r4PP_RavA4:<` ,.,=y f -------------------------------------------------------------------------------------- ------------------------ --------- s --- ,. - _ - - �---- S (Draw existing a:nd,required addition on reverse side} I hereby certify that I have prepared this'-application and that the work will be done in accordance with San Joaquin County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner or licen- sed agents signature certifies the following: "I certify that in the performance of the work for which this permit is issued, /hollnot oy any person in such manner as to be com subject to Workma o nsati.on la s of California." r Signed - Owner By -Title --- --- ------ ---------- ------------------------ ------- otherthan owner] FOR DEPARTMENT USE ONLY / -- F ` jl ±; APPLICATION ACCEPTED BY ---�.--E�- -y0-'-------------------- ---- -------------------- ----------------------- DATE t ----------------- BUILDING PERMIT ISSUED -------------------------------------------------------------------- ---------_--------------DATE ------------------------------- q ADDITIONAL- COMMENTS -- -� --$7�M__. -J__X6T__t9 `}Tt.D__/V_.__ - -- --------------------- - D -I=-- ------------�__:- ------ -------- ---- --- - _ _--- - -----:---- ------------------------------------- -------------- ----------------------- s __- w . -- - - - _ r ---- T- ------ - ------------------ --------------------------------------- ------------ ------ ------------- - - ---- - - -- ------------------------------------- -- --- ------ -- --- ----- ------------------------------------------------------- Final 9ns echo -------- Date I] �_- �--.`-,-'-----.-moi--�."-L`=-�'?� �~-- --~-�-C�---c--`---- ___w__�.-_ .._.__ - - -•- -~- ' - V SAN JOAQUIN LOCAL HEALTHDISTRICT E. H. 9 v 1-'6B Rev. 5M.