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FOR OFFICE USE: 11 FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT i Permit No?.9 �! ------- -- ------ ----- (Complete in Triplicate) -.--6-... . -. This Permit Expires 1 Year From Date Issued Date Issued.�z. 5:--;l I 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: J08 ADDRESS'/ ---------------- ---CEN US TRACT. ..-... Owner's Name... :u. - Iii iA►.yhS = ....... .......................... � one ----��--------�=----Address....... �ijjame.__- 6. K�e,��?°� V.- #U 9i 1 90 i ....... .. Cit p-..: .Y. .... - iContractor's .... R- f�.�._ . yCF/ OA --------- License # Phone-------- --------- - .. Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other.........-----.. ..:. Number of living units;................Number of bedrooms...._-.._.. rbage Grinder------------Lot Size.-----------_ . i). Water Supply: Public System and name....... ...:.. ......... --- --- ----- ----- - -----------• -------- --- ------------ •..---Pr Private Character of sail to a..depth of 3 feet; Sand NSilt❑ Clay ❑ Peat ❑ Sandy Loam ❑ Clay Loam ❑ .�, Hardpan Adobe p ❑ k 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.) NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,[ PACKAGE TREATMENT [ ) SEPTIC TANK I X X �� [ ) Size......_.. ---- .Liquid Depth.- ---------- Co ------�, Capacity..�IZ�U--- --TY,pe--+ r Material.. �^- � C'c}n No. Compartments = i Distance to nearest: _-- - 2 d .--......_Foundation--- - ---- - -- _.Prop. Line-------- -------- ------- ` t LEACHING LINE. [ ] Na. of Lines '°� ) ---•-- Length of each line........ ------------- Total Length !i 9 11 ---------- -. -----. .� ( v . 0... i ,ox :.Type-Filter Material.... ..:...Depth Filter Material. ------------------ --- ------- o Dista I h q � 2. y ai ' B nce.to nearest:,Well_....._... -'- ...-----.Foundation.------��- :=:'......Property Line.----:t.b.._____.-.--}-.--.-... SEEPAGE PIT [ ] Depth-- ....... .Diameter----�- • .....Number--------------------------------- J tf� Rock Filled Yes No ❑ Water Table Depth,--•--------------tfab=.:: . ---............Rack Size---.---------------------- � 7 Distance to nearest, Well----..-..._4....i..............._.........Foundatron----_ --.-.--......- Prop, Line.---- -.--.-- --- --- --. REPAIR/ADDITION (Prev, Sanitation Permit#..................' ---------------Date-------._............ Septic Tank (Specify Requirements)...... ....... . - -�—�= ----------------- ---------- ----- Disposal Field (,Specify Requirements)_ _..----.-. : -------------------------- -------------•-------•----•------ ... -............--------- -- -----........... -- E .I:............ ` 1 F ......................... ...----.:..__........_...........----_..-_--...._..............--._.........---.....-.__._.--_-----:.....--...-- I .................... .. a- --------------------..------------ _ IC . ................................................................................................._.-... 1 (Draw existing and required addition on reverse side) % I hereby certify that I have prepared this application and.„that the-” ork 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 licensed agents signature certifies the following: "I certify that tln the performance of t e work for which this permit is issued, I shall not employ any person in such manner as to become subject to Workman's C pensation laws of Colifornia., E Signed.--.-... r_.._.-... _Owner BY-------- - -------------- ------ Title'.. -------....----- -- ! (if other th n owner) ,t ff t i DWARTMEPOILIJE ONL APPLICATION ACCEPTED BY--..... -- - /Yh -^-- ....0. ........DATE .. C ....... DIVISION OF LAND NUMBER .. .............:. DATE. ADDITIONAL COMMENTS............ - 1 .............. ----- ---.... ---.-•-•• II1 -------- - ---- --------------- - - ---- q 0 12 Final Inspectan - ... ---------------------------------- Eli 13 24 SAN JOAQUIN LOCAL HEALTH DISTRICT Fas 21677 REV. 7176 3M