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�..�- FOR OFFICE USE: . d �, .AP—PLICATION FOR SANITATION PERMIT ----------------------------------------- �. (Complete in Triplicate) '-� v. Permit No. _4-.9' ---------------------------------------------- T --- This Permit Expires 1 Year From Date Issued Date IssuedG� o� Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This ap�li�tion 's mace 'n compli[[a��nce with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESSjLOCATION ._-- ----//- ----- 1_L_f `�-p_ --------_M-AW D�� _______________CENSUS TRACT -------�- ._ -- --------- Owner's Name --------------------u r-l'l-------- - _ii .A K------------------------------------`- -------------------Phone ------------------------------------ ZF Address vi`1't ---------------------•--. City __ r7rI -- -- ------------ _ Contractor's Name-RR ------------ --- - -V---A--;--G------I-- ----------.License #1a®.1` %i----- Phonexf -4e Installation will serve: Residence ❑ Apartment House❑ Commercial ❑Trailer Court Motel ❑Other -------------------------------- ----------- Number of living units_____________ Number of bedrooms ------------Garbage Grinder ------------ Lot Size ___________________________________________ Y Water Supply: Public System and name --------------------------------------------------------------------------------------------------------------Private Character of soil to a depth of 3 feet: Sand'X Silt❑ Clay ❑ Peat❑ Sandy Loam [] Clay Loam ❑ Hardpan ❑ Adobe-E] Fill Material ____________ If yes, type ---------------------------- (Plot ___- ------------------(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 or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT K SEPTIC TANK[ ] Sizer`1s!,"AA._ 04-�_.04ty___ Liquid Depth ----__-_________ Capacity -------------------- TypeM-16401 W- Material_ , No. Compartments W___-_-_:.__. Distance to nearest: Well lep-t__JC:f ______Foundation ----a-a"_______-__ Prop. Line _ ___c_______ LEACHING LINE [ ] No. of Lines ------------------------ Length of each line---------------------------- Total Length _____-___-___-___-___ 'D' Box ------------ Type Filter Material ____________________Depth Filter Material _________________________________._-__._ Distance to nearest: Well ------------------------ Foundation ----.------------------- Property Line ------------------.----- SEEPAGE PIT [ ] Depth ____________________ Diameter ________________ Number ---------------------------- Rock Filled Yes ❑ No Water Table Depth -----------------------Rock Size -------------------------------- Distance to nearest: Well ----------------------------------------Foundation -------------------- Prop. Line -_------------__------ REPAIR ADDITION(Prev. Sanitation Permit# _-_____ .________ ____ Date ____________ 4 Septic Tank (Specify Requirements) -- -- ------- ---------------- -- _-- -- -- ------------- Disposal -- Disposal Field (Specify Requirements) _ - _-- _ ___-- L�---------- ----------- ------- - - ----g- --------- - ---1��_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 San Joaquin Local Health District. Home owner or licen- O sed agents signature certifies the following: "I certify that in the performance of the work for which this permit is issued, I shall not employ any person in such manner as to becom su ject to W man's Comp safiion laws o California. Signed . - ---------- Le, Owner '� - ------ r ��'s -------- -- Title 1`L. .�r------------------------------------------------ rr �� f other than owner) FOR bEPAR ENT USE ONLY APPLICATION ACCEPTED BY 9-`--O------------------------------------- -----------------------------------•--. DATE ---3.--.17 -6-P ------------ BUILDING PERMIT ISSUED ----------------------------------------- DATE - ---------- `-- ------------- --------------- ADDITIONAL COMMENTS - � ----------------- --- - ----------------------------- 5-X-TEFME$11 B FtEf rf�__% _r----Pro -- ----- �_ _` E P=----90-- QUIN- -- - --=-tag _ _ 1/F-.c b------DEQ v►-Res------kPAY ------------------------------------ ----- -- ---------------------------------------------------------------------------=•------ Final Inspection by: --- -----------------------------------------Date ---- � ---- ----- le SA LOCAL HEALTH DISTRICT E. H. 9 1-'6B Rev. 5M