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FOR OFFICE USE: 10031 2-u rl (el APPLICATIO FOR SANITATION PERMIT , iJ ----------------------------------- Lf`,2.1� (Complete in Triplicate) Permit No. --------------------------------_---------------_-------- This Permit Expires 1 Year From Date Issued 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 i made in compliance with County Ordinance No. 549 and existing �Rules , Iangutions JOB ADDRESS/LOCATION ._ ._____-- _--_-__- _______��' _ -CENSUS TRAC --------------------- Owner's _--_ n_ - : Owner's Name ------- --- --- flytt� ----- = ------ --------Phone ----------•------------------------- Address ----------- -- ---- � City --- - -- ----- ------------------------------------------------------- Contractor's Name �- - - ---- -- ---- - ----- -------------------- ------ - -- - ------f-----.License #f�---�1-- [- Phone ��• "e� Installation will serve: esidenceXApartment House❑ Commercial ❑Trailer Court Motel Other-------------------------------------------- Number ---------------------------------- ------Number of living units:_________ Number of bedrooms __j_ rbage Grinder __AjL?___ Lot Size ____ ----1<._15V. Water Supply: Public System and name ---------------------------- - _-- ------Awlike-------•_---_---•-----Private ❑ Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam,❑ Hardpan ❑ AdobeA Fill Material ------ ----- If yes,type __-________._____..___-__ W (Plot plan, showing size of lot, location 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,)��r PACKAGE TREATMENT [ I SEPTIC TANK Size____ __ / `�'<<r _ _ Liquid Depth ___ _________________ � L ------/--�-- - --------- ------ ---- Capacity _ rZ4 ,.__ TypeP,4 Material_ t __ No. Compartments .. ............ Distance to nearest: Well --- -----------Foundation -----4e-------- Prop. Line ----------` .... LEACHING LINE No. of Lines I------------------ Length ��ovvf each line---, _------------ Total Length ---- .....le........... 'D' Box ------------ Type Filter Materi( _4DepFh Filter Material ----- �------ ....................... 14 W Distance to nearest: Well -�------ Foundation##----- ----- Property Line ---------•-------.•----- SEEPAGE PIT [ ] Depth ___ __ Diameter ---------------- Number ---------------------------- Rock Filled Yes ❑ No 0 Water Table Depth ---- -------------------------------------------Rock Size ------------ ................... Distance to nearest: Well ---------------_------------------------Foundation -------------------- Prop. Line ...................... REPAIR/ADDITION(Prev. Sanitation Permit# ____________________________________________ Date ----------------------------------) Septic Tank (Specify Requirements) --------------------------------------------------------------------------- ---------------------•-----E------------------ - ------ Disposal Field (Specify Requirements) _------------- _______.___-___________ ------------- ------------------------------ -------------------------- --------------------------------q ------------------------------------------------------------------------------------------- - (Draw existing and required addition on reverse side) 1 hereby certify that 1 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, I shall not employ any person in such manner as to becoRAUJQ &F V4ak{ 9*3G,C@SIMt on laws of California." Signed -------------- P. O_. Box 254 ,. s�► --------- 160-East Grantline Road---------- By •-------------------Tr c Catifornr --9a3-1-6------------- �� Title (If ot�ie than owner R DEPARTMENT USE APPLICATION ACCEPTED BY --------------------------------------------------- '`. DATE ----J4�,.,l�3—�a �. - ----------------- BUILDING PERMIT ISSUED ____________ _____DATE _.____._________________-__-__-___._____ ADDITIONALCOMMENTS ------------ --------------------------------------------------------------------------------- ----------------------------------------------------------------------------------------------------------------------------------- -------------------------------------------------------------------------------------------------------- ---------------------- - - ---- - - - - - - - - - - ----=------- Final Inspection b ---- -- -- -- - -- - ----------- ---- -- p y: ---------------------------------------------------------------------- ------ --------------- - - -------Date _JO-_'L9 iG,---- SAN JOAQUIN LOCAL HEALTH RICT E. H. 9 1-'68 Rev. 5M