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F6R OFFICE USE- APPLICATION FOR SANITATION PERMIT 7<-/---• -• - - ................-------------------- (Complete', Permit,Triplicate) No. ..........:.. Date Issued __ _4f f This Permit Expires 1 Year From Data 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: E�s. ��tt��r� - JOB ADDRESS/LOCATION .rte g•,'""°�,,� ............... ' ixs'' 'rv ..CENSUS TRACT ........... Owner's Name _. 1 SKc �w I ---------------- Phone `' City ................:.. ...... ................... Address • crit S�•`s -•nom• _...... license # -s`f:3....... Phone ... i!a-�`Z'fin�7... i Contractor's Name ...._.__74�.. +`�! ! ••••-- --•---. Installation will serve: Residence{Apartment House❑ Comrnercal oTrailer Court 0 Motel ❑Other ....................... ...... ... ._.. ....:_ P_ Number of living units:---- Number of bedrooms .3-......Garbage Grinder------------ Lot Size :._1'�...._zC.Zoo._____---------- I �r� - __.... ...Private ❑ Water Supply: Public System nd name ____________________ Character of sail to a de th of 3 feet: Sand Silt Clay Peat i Sand Loam Clay loam p ❑ ❑ Y C7� O Y �❑ y ❑ V cHardpan ❑ Adobe Fill Material A__. ..... If yes,type __--__----- ..------ O : (Plot plan, showing size of lot, location,af..,system_in_relation—to�wells, b Jild�ngs, etc. must be placed. on reverse side.) NEW INSTALLATION: (No septic tank or seepage pit "p�e�rmitted ifpublic sewer is available within 200 feet,) PACKAGE TREATMENT ( } SEPTIC 1ANK '"J Size.... . ... ...................... Liquid Depth _ .. ..,....- � Capacity !.f.t 7 Type P. -�~... Material---- Compartments __-- ....... Distance to nearest: Wel_:.- __._.._.__.. Foundation ---70_........... Prop. Line ...................... i q.� Total LEACHING LINE No. ofAines��.__.0 `.--------- Length of ach=line---- 5•I----:-.._..•.. length ---....� .............. .�'�rO Fl:..._ L7 D' Box �✓� .__.T e Filter Material .. of Depth Filter Material _.__�................................•, 11d .. 1 �yl 43 ',• -� �.. lam- --- t`P`r-o .er?y)Lina .�.........:::. Distance to nearest: Well ._,50�.__._...._ Foundation p - w j'�Ro& Filled Yes No SEEPAGE PIT (A Depth _.0� '--.. Diameter _. 5�1.�._- Number ....... _ ❑ 7 I -• t+ • Water Table Deptht4.--.....� ._ ..........-•-------•----Rock Size _.__..--_--- •-•--- , ..... Q-------- Pro line . r Distance to nearest: Weil.....__-_ .................. ......Foundationp• .............. I REPAIR/ADDITION(Prev. Sanitation PeE'miit##.••.--..-- ................................ Date .F............................... ) i Septic Tank (Specify Requirements) _....: i------------ ---_-- -----. ----------------- ........ ........................•------- -...-,_...-•--._._.._..........------. p . Disposal Field (Specify Requirementsi ), -••--------- •••. • • ------------- .......... ......................... I ------------ ----------------•-•--- .............. .---•-------------------- ----------- .......................................... ----------------- _ .............................. ..... (Draw existing and 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 Son Joaquin Local Health District. home owner or Iicen• sed agents signature certifies the following.:{ .<E - "I certify that in the performance ef�the work for which this hermit is issued, I shall not employ-any person in such manner as to become subject to Work' an's Compensation laws of California." Signed ............ . ................. --------•------ ._....:.. ----------- ----........... Owner X BY ._.._.. .. __ ._ ...... Title ...._---- (If other than owneii r) FOR DEPARTMENT USE ONLY APPLICATION �ACCEPTED�BY -----•.....................•------.-.-....---------------...:........---....._. DATE .__.'A.: A ---........._....BUILDING PER ----•-•---- ...:. ......................................DATE .......................................... ADDITIONALCOMMENTS ..._."......................................•••-•---•----------------•...... ........'...........:...._-.........................-........................... #_ •.....................•----...._...... ---------------------------------•----• -•-------•------------.........---------------------------=---•--------•---------..._...........---•----.............---......._.....__......_........ •. -•----..--• . . ................... ........................... ' Final Inspection b `' �. .. .. .. .. .......... ...........................•... 3-...-1L ti._......... Y --------------p ---------y.• •_• -f---..._....:..,.._.Date ....�.:_.....----••---- ......... SAN JOAQUIN LOCAL HEALTH DISTRICT C,13 C 13 24 7/723 ,A