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FOR OFFICE USE: APPLICATIONFOR SANITATION PERMIT Y� Q ----------------- - Permit No. {Complete in Triplicate) ----------__-----------_---------------------------------- .R r1 . Date Issued ...0-_. "_7-- This Permit Expires l Year From 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 .-. :�� _ _., QIN Fes' L" �`- ------------------------CENSUS TRACT --�'- ------- I 1 ------------------------ Owner's Name. �, i �"f'E ��Vhho s,/,.,,� Pe Address ---- 3-23�----� _ /v - E -----. City Contractor's Name ---.40wN�jt�------------------------- ;------------------------------License # - Phone - Installation will.serve: Residence *1 artment House'❑ Commercial ❑Trailer Court i❑ / Motel F1 Other -------------------------------------------- r Number of living units:_/------- Number of bedrooms _-%3----Garbage Grinder_---- Lot Size ---� 04- --------- } Water Supply: Public System and name -------------------------------------------------------------------------------------------------------- Private Character of soil to a depth of 3 feet: Sand'❑ Silt Clay ❑ Peat❑��= , Sandy Loam ❑ Clay Loam I _ Hardpan K_ Adobe'❑ Fill Material _T�IIC'!J__'_ If yes,type _______________________ ___ (Plot plan, showing size of lot, location of system in relation to wells,,huildings, etc. must be placed on reverse side:) NEW INSTALLATION: (No septic tank or seepggpit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ SEPTIC TANK'[ ] Siie----------- ----------------------------- Liquid Depth ---------------------.----- r Ea ----------------- Capacity r I s # Ca acit e----- '- T -------------------- Material--------------------- o. Compartments P Y ---- ;--- YP Distance to bnearest. We _ _____- '_ _____Foundation _-.-__ __ ---------- Prop. Line ---------------- ry, i / Total Length :---------- --------- LEACHING LINE; [ J No, of Lines ________________ __ Length of :each line------------------ -- --- -- g 'D' Box ____----__._ Type Filte Material *_:'-________________Depth Filter M terial ------------------- ' )� I�, Distance-ito nearest: Well _ _______ ____�_____ Foundation Property Line .--______._____.....___ ---------------- I t3 t Je' SEEPAGE PIT �[�] Depth _ 1----------- ---- Diam ter _"______ _:-_-- Number ---------------------- ---- Rock Filled Yes ❑ No I❑ r { I - ----- ' -------------------Rock Size ----- Water Table Depth --____-- ----------------� - ? ,l `D tante to nearest: Well - ------- ----- ---------------- Foundation ---- Prop. Line ----------•-----...... REPAIR/ADDITION(Prey:Sanitation Permit# -------- -- --- -- ------ ---------------- k Date te �---------------------------------- ------ Septic Tank=(Speci y equiremgntg1 ----_ ------- } ---------------- Disposal l Field (Specify Requirements)'-N- --------- T " T------------ ----------------------------------- ------------------------ _E&C litty ------------------------------- ------------------------------------------------------------------------------------------- -. --------- --_ accordance with San Joaquin I (Draw=existing and required addition on reverse side) ' 1 hereby certify that I. ha-ve prepared this application and that.the work will be done in accords q County Ordinances, State Laws, 'and Rule and`Regulations of the San Joaquin Local Health District. Home owner or licen- sed agents signature certifies the following: "I certify t in the perfor ncet f the work for which this permit is issued, I shall not employ any person in such manner as to becosubiect to o man's A�sfl laws of California." Signedi Owner i - ° y- y __________________________________________ BY ----- - --------------------------- -------------------------- --f- --� - Title ------- - ------------- I hif'other than-i'owner)' t I t 1; �v �"i�" FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ----T RAr_0--c--------------------------------------------------------------------------. DATE -----Iry BUILDING_.PERMIT_I.SS.UED--------------------- - ---- ------DA_TE---------------------- ------------- ADDITIONAL COMMENTS .-.._ .._ T _4_ , -�.----- ___._ ------------------------------------- ----------- -.. _________________________________ ______.__________---- ___ _______ --_ _______----.----.___-.______---_____-_-_______----._______-______ Final Inspect) Dae ._. SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1268 Rev. 5M