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rOR OFFICE USE: Y —•— A+ APPLICATION FOR SANITATION PERMIT -------- ----------------- -• ..•...._.._.._. . 7s-- o (Complete in Triplicate) Permit No. i ..................... . 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 is maI de in compliance with County Ordinance No. 549 and existing Rules and Regulations. ' ' JOB ADDRESS/LOCATION d .,. .Q_v .. / _.CENSUS TRACT .................... Owner's Name ._.. PltT ---------------------------------------------------------- ------- ------------- ........Phone•-�.Z '-=P?52 3.---- ( Address -_1. ..y.�fj�--....._ ��..�. STL�` ......._-------------•. City . ............................•........ k Contractor's Name .-. y. ..lJ License #C Phone Phone f . Installation will serve: Residence W Apartment House❑ Commercial [-]Trailer Court ,❑ Motel ❑Other ------------------------------- ------------ G ll g I. Number of bedrooms -3-___.__Garbage Grinder ....-......• Lot Size .-.f_ ........... Number of twin units:... . _ � -- .............. .. i Water Supply: Public System and name .._•..........................................................................................................Private f 1 i Character of soil to a depth of 3jeet: Sand 0 Silt❑ Clay ❑ Peat❑ Sandy Loam �K Clay Loam ❑ Hardpan ❑ Adobe ❑ Fill Material ............ If yes, type .- ...... (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc, must be placed on reverse side.) I NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) fJ� PACKAGE TREATMENT SEPTIC TANK-[ Size. ..... Liquid Deptt �' . ........--- , � . Capacity . Type�ie C Material..._.... No.No. Compartments .__-Z -:.- .------N --. - - - -- - � "O_ �.. _ o Distance to nearest: Well..--..._...--------------Foundation .14._...._..-.-- Prop. Line _�Q..-._._.... LEACHING LINE [ ] No. of Lines ... .-.. . ._. Length of each line ............ Total Length .c ;l ................ I 'D' Box ._/ Type Filter Material /__Depth Filter Material _ff el............................... O Distance to nearest: Well J.. ._. .. . Foundation D-tl - 4 ".11...........: Property Line ...� ..........:.. k SEEPAGE;PIT [ j Depth Diameter ________________ Number . :._._. .... ............._ Rock Filled Yes ❑ No J { Water Table Depth ................................................ Rock Size ,.......-_...�-:..._•------ Distance _- .Distance to nearest: Well _........_..._.. ............ .........Foundation ._........_.._._... Prop. Line _._.._.__. ........... REPAIR/ADDITION(Prev. Sanitation Permit# -------- ---------=------------------------ Date ----------------------------------) Septic Wank (Specify Require t�sM.�..-.,.. �..,= .a '�' ..., "_:-------- ; '---- : :_:'..-::-----•--- -------------------------------•--------•-----•--- Disposal f=ield (Specify Requirements) ......... ' �� ......................... .... .._._._...1.......................... .....................................t.-------....................................................-._.-.-..............._...._..... ................. r k ,_,.._,,.... Fs.. ----uired addition and re,: -'. ,•. . ... .... ...... --------------------------- (Draw existing `� q on 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 San Joaquin Local Health District. Home Owner or licen. sed agents signature certifies-the-Following:. ( i "I certify that in the erformance of the work for which this permit is issued, I shall not employ any person in such manner Signed , fu- _.-n laws of California." Jf �. 9 .......... Owner as to become su to r m s o _ensat+o � fi By ...: . .. . ....:..: .__...._....f . .. ............... -•----....... Title . .... ?...,.....-._........._.. (If other than owner) z" FOR DEPARTMENT USE ONLY _ APPLICATION ACCEPTED-BY ..., ..._. ......... DAVE ._...; "..__.. .................. BUILDING PERMIT ISSUED ._.._. ... ...€...... ......: DATE . ----•------------•--- ................... .......... ADDITIONAL COMMENTS,.... ----------- a. ......_ _... _..._.. ............ - = .�. ---------- .. - . _. - ._ _ , t .-----•................_.....---•--p ----- .....................................................----------------.---------------------............................................ r - -.....--------- ------------- ------- ::.._..._-._.. . ------ .......- - - Final Inspection by: ..- - -• •-----•------------------------------------ Date -•- •-=I. ., ... �� SAN JOAN PIN" LOCA.L.,HEALTH DISTRICT E. H. 1.3 24 1-,6s Rev_ sM