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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT - (Complete in Triplicate) Permit No: �-_ F. ---------------------------------------------------------- _J�. v-�- 70 & -------------------- This Permit Expires ! 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 is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: , ;. JOB ADDRESS/LOCATION 0 �� ---P-_t-----------------------------------------------------CENSUS TRACT ----��_____--_--------- t Owner's Name ------IRAL"bl 5w----U.4S �-------- ------------------------------ -----------------•---------- --------Phone M S71 SN�---------- Address -------------------------- ----------------------------------------------------------- City ------------- ------- ------------------------------------------------------ Contractor Name - -------0CQ31LQ�_------------- ---------------------------------------------License # ----- --------------- Phone -------------------------------- Installation -----------=----------- -Installation will serve: Residence ❑ Apartment House❑ Commercial :❑Trailer Court ',❑ Motel.❑ Other -------------------------------------------- Number of living units:----------- Number of bedrooms ------------Garbage Grinder -------- Lot Size ___- -------- __----_________________________ Water Supply: Public System and name ----- --------------- -------------I------------------------- ------------------------------------------------Private ❑ Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam Hardpan EJ__ Adobe ❑ .Fill-Material_.Y._c__--- IfyesJype---------- __ -------------- (Plot - ----- . (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed"on reverse:side.} y NEW INSTALLATION: {No septic tank or seepage pit permitted if public sewer is available within 200.feet,l, .L PACKAGE TREATMENT [ ] SEPTICITANK'[ ] Size-----------------------------------=----------- Liquid Depth -_----------:___•--------- Capacity --_-Capacity -- ------------- -- Type -------------------- Material------------- ------ No. Compartments ." Distance to nearest: Well ------------------------------------Foundation ---------------------- Prop. Line --------- LEACHING ----- -LEACHING LINE [ ] No. of Lines ------------------------ Length of4 each line -------------------- Total Length __-___-_.`_.__..:,.-k.__,.:.:_ 'D' Box ------------ Type Filter Material --------------------Depth Filter Material --------------------_--- -_--:- : u:.: p ty :. •. "Distance-to nearest: Well"-____-______-___- Found�iti - ______-___�--.__ Pro r "`eine-______"_�`_`_= � r� . n SEEPAGE PIT [ j Depth -------------------- Diameter ---------------- Number _________________________ _ Rock Filled Yes 0 "No Water Table Depth ------------------------------------------------Rock Size ------------------------------- Distance to nearest: Well ----------------------------------------Foundation -------------------- Prop. Line ---_-__-- -_ ' ! REPAIR/ADDITION(Prev. Sanitation Permit# --------------------i_%----------- ----- Date ------------------- - --- Septic Tank (Specify Requirements) ------------- 19.W.00-o- f�- ----.-- --------- --------- = ---------- , 5 Disposal Field (Specify Requirements) --mac ..._._�°__._ _p --X -�______:__--F - _ 1 jf Ti --- ----------------- -------------- ------- ------------------------------------.___._---_-____.-_____-_-_____-_._-_____-__-____-_--_____-_-_-----_____--•__-_----_--_------_________.--.--_-____-____-_-________._.____.__--_--__-_--_--------._ ` 1 I�«.- _. ' '_ - "^"'-' - ._.' -------- -_.'�----` - -fr.�___ _ -----------------------------__II__. z-_— ___.. �___ _____`�__ _______ ________________ _________________.._ .� awl, __ -------- ---------- '.-.��, c (Draw existing and required addition on reverse side—) I { II 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.'Disidd. Home owner or.Iice n- •�I .. . sed agents signature certifies the following: "I cerfi.fy that in the performance of the work for which this permit is issued, 1, shall not employ any person.in such mariner as to become subject to Workman's Compensation laws of California." `. Si ned , r - ---- - , 3 9 Owner BY --- ----------- --- ------ Title :---- ------ --- - , ' (If of r than owner) ` FOR DEPAATMI° US ONLY, L 4 « y APPLICATION ACCEPTED BY � l - _ -- -- ---_-. BATE r0 t BUILDING PERMIT ISSUED : - -------------- DATE ------------------------ ADDITIONALaf COMMENTS --------------------------------------------- = - -- -- -------- - =---------•--------------------- ---- ------ ------------------------------ __ - - -- - ----------------- -- -- - - ` Final Inspection b ... = G - -Date s i � , j - SAN JOAQUIN LOCAL HEAL D15TRICT 9 l H. 9 �. 1- 6b�Rev 5M' -A _: