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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ---- Permit No. (Complete in Triplicate) ; -------------- This Permit Expires f Year From Date Issued Date Issued __LF'iU-_7L -------------------- ------------_------ 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: _ I .___CENSUS TRACT --- �_ /-.______-- JOB ADDRESS/LOCATION 2911__J------�nn------L.-EIY�Q[V---------------------------------- ---._. , Owner's Name J l? R_T 1-llC AR-711\1-------------------------------------------------------------Phone .�3--------- )-_�`�_ _---- Address ---- -------1102-�--------�=-------L- / ------------------------. City ---------------------------------- i Contractor's Name ------- --------------- ---------------------------License # ------------------------ Phone ------------------------------ Installation will serve: Residence Apartment House❑ Commercial :❑Trailer Court Motel ❑ Other ----------------------•~'-- ---------------- Number of living units:----J------ Number of bedrooms 3-------Garbage,Grinde/�_5- Lot Size _ _---(-__ FA�---------------- - Water Supply: Public System and name ----3----------------•----------•---------------�'--------------------------- ------------------------ --__Private Character ofs`oil'tb a'depth'of 3;f�et: Sarld'❑ Silt❑ , Clay _❑ Pe t❑� .rSandy © oam ❑ Clay Loam Hard ❑ P Adbbe' i-Fi1J-N1`aterial _��y.0_ If yei,type ____------__- - _ _o NND (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 ori seepage pit'permitted-if-public sewer isavailable within 200 feet,) V; PACKAGE TREATMENT [ ] SEPTIC TANK'S ] Size-------_--!-------------------`'-------'-- --.- Liquid/Depth --------------------,--•-- �: YCapacity -------------------- TypW`-- ---------------- Material------------- -�;�-F o. Compartments Distance to nearest: Well ___ ____________ ______Foundation _'__; ____ _- Prop. Line ___________. -------- LEACHING Ll `M ----------- NE [ ] No. of Lines ---- - --------- ngthtiofe��li- ---- ---------- -- -�,�Tota! Length ---- •----,- - - ' 'D' Box ------------ Type Filter M teriol -------------- teriai --------------------•--------_------•------ Distance-to--nearest: Well ------- -- ---j:j .__ Foundation -- ----------- -- Property Line -------------_-------- _ _.� _ 1 `r i Diameter Num Number Rock Filled Yes ❑ No SEEPAGE PIT [ 1 Dept -- -- r --- -------- b Water'Table Depth Rock Size -------- _ stance to nearest: Well --------- -----------------------------Foundation .-- --------------- Prop. Line ------------_ ------- REPAIR/ADDITION(Prev. Sanitation Permit# ------------------ Date __________________________________) 1/fit` Septic Tank (Specify Requirements) ------ �/�t'1_L�-R -- --------� J�'T.rN1------- -------�l4Tf�_ 4.Q- I------•-_--------- Disposal; Field (Specify Requirements) � L ------------ � 6 "DIv P _ '_ / l (0l1/Cf" P !_�------`TSN ---- ---------- 1-1-N-1 ------ ----------- ----- .,_._ _ a--. ..T - � 'r --------------------- ----- ' - --------------------------------------------------- ------- "' --- -------------------------- a r -� {Draw existing and required addition on reverse side) I hereby certify that I have prepared this application and that the work 3WI be done in accordance with San Joaquin f County O�clihances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner or iicen- 4, " sed agent'isignature certifies the following: "I certify t in t e pe orma of the work for which this permit is issued, I shall not employ any person in such manner as to be` e:su Iec or m s nsatiori laws of California." i S ;.. 'sgned �_. . _ . Owner By -------- Title ---------------------------------- E (If other than owner) ! FOR DEPARTMENT USE ONLY ` APPLICATION=ACCEPTED BY - ! .C�- �.5-- -- - -- --- ------------ -:DATE 17R-- - _ BU[LDLI __P5RM17 ISSUED_ - :- _=-_ : _.,_ DATE ADDITIONAL COMMENTS ---`-------- -------- -- ----\ - -� -------- s -t ------------------------------------------ --- ..:: �;; ----__ .� . ------------------------- ------------------------------------------------- -7- ___._. _.— _ _. --------------- ---------------------- ----------- ---------------------- --- ---------------- - -- - - ------ i Fipal lnspec _Date -- -- -��`�G---- - ------- --- - - SAN JOAQUIN LOCAL HEALTH DISTRICT i - i E. H. 9 1-'68 Rev. 5M