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. FOR OHICE.USE: _ APPLICATION FOR SANITATION PERMIT - (Complete in Triplicate) Permit No. _. p__`_------_. _____ This Permit Expires 1 Year From Date Issued Date Issued --5�'/ �7d 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 lwith�County `O�cligance No. 549 and existing Rules and Regulations. JOB ADDRESS/LOCATI N --_26.0.7 ___,---F....-----M_NHOrV----------------�SC_ ------------CENSUS TRACT ---�`_�q---_---- Owner's Name] 7FP -------- ----- �_-�_ -� D-=----------------------------------------------•----------- -------Phone I F Address - -- /4'1_!�} 1-�_0- ------------- City _ cr ` Contractors Name E,�WN - License # Phone d3. '_9!W3--- -- ------------------- lnstaflation will serve .� Residence 01partment House❑ Commercial []Trailer Court ;❑ Motel ❑Other Number of living units------- Number of bedrooms _3 ,,_:_Gcirbage Grinder IVO-r--- Lot Size ...A�FoE 4_GF-_________-___ Water Supply: Public System and name -----------------------_ --------------------------------- i--------------------------------------------------Private of soil to a depth of 3'feet: Sand ❑ Sift[f.-` Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam:fi Hardpan rs Character Adobe Fill Material _ 4_ _v*__ If es,t (Piot plan, showing size of lot, location of system ,fn relation to wells, buildings, etc. must be placed on reverse side.) NEW INSTALLATION: (No septic tank or seepagepit permitted if public sewer is available within 200 feet,) I PACKAGE TREATMENT [ ] SEPTIC TANK f ] i' Size---------------------------------------------- -- Liquid Depth ------.--------------- ---- { a Type ;if- T Capacity Material --- - ---- N Compartments Distance to nearest: Well i --- ---------- ------------Foundation -------- ------------- Prop. Line ---.--.--_.----------- LEACHING LINE [ j No. of Lines ----------------- ----f Length of each line--------- ------------------ Totpl(f Length ______.__.,.._.-------- i 4 1 'D' Box ---------�� Type Filter terial :-___-�^_:----Depth! Filter Ma erial ------------------- ------------------------ Distance to nearest: Well _______________ Foundation -.1---------------- _ __ ___ Property Line .__ ____._________-_ /7` .h L ] p r-',<<•�---`'-' Rock Filled Yes ❑: No SEEPAGE PIT Depth �..____-_ Diameter. ,Number ______�__._________ ' C1.s� i Water Table Depth - ___r- ----=--------Rock Sfze - `------------------- > . Distance to nearest: Well ________ _ ____________________________Foundation _____ Prop. Line -------:__._____-__._- �. REPAIR/ADDITION lPrev. Sanitation Permit# ---------------- ---•----------------------------- bate ----------•-------- --•----------1 Septic Tank (Specify Requirements) i ----------------------------------------------_------------------ ----- ------ _ _ I ' " Blip K Disposal Field (Specify Requirements) _17J'�(. ----- -------FX1$Tl_t1f =--_----- 11M ' Lig Tf� N �a r _6F...----2_x_11------I—EA -Er,�-UNF �f �X : x , _._.__ =-------------------------------------------- T-------------------------- ; (Draw existing and required additio on reverse side) I hereby certify that I haveprepared this application and`that the work will be done:in accordance witli San Joaquin County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner or licen- s sed agents 'gnature certifies the following i "1 certify t t i the perf r once of the work for which this permit is issued, 1. shall not employ any person in such manner as to bec me s lett to �an', pensation Paws of California"Sign --------- - - ------- '----------------------------------------- Owner �• a BY --------------------------------- ----- , - --- ---------------------- (If other than owner) f :ti FOR DEPARTMENT USE ONLY-------------------------------- i LI�N ACCEPTED BY wiBUD1NGERMIT ISSUED _ E _ - - ---- --ADE ITIONAL"COMMENTS--•------- - _- _ --- ------------------ --------------------------------------------- -- --t------ ___________A____,_"1.3_L.r_4 ------ - ----------------------------------------=-------'--•-• ------------^------------- ----------- -------------------- --------- Final Inspection bY: - -- ------ ------------------------------------------------------------------------------- ----- --- -- --------- - -'- - ------- ---- -- ----- -- - - ----------------- --- - ----.Date ---�_ �' �.--4- ----- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'6$ Rev. 5M