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FOR 0FfiCE USE: APPLICATION FOR SANITATION PERMIT (Complete in Triplicate) Permit No. - G j ------------------------------------ -------------------- This Permit Expires 1 Year From Date Issued Date Issued Application is hereby made to the San Joaquin Loca{J)-leal1h District for a permit to construct and install the work herein j described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: I r JOB ADDRESS/LOCATION __ Q_ ----------- TRACT __-- Owner's Name ---------- -- 4E C ---------------------------------------------------------Phone ------- ------ -X3.6- ------------- Address /-------BA—(-D. _-• City }LCJ - C A Contractor's Name ------0+V J��------------------ --------------------------.License # --- ----- -----j----- Phone ----------------------- --- Installation will serve: Residence partment House-E] Commercial {]Trailer Court '❑ Motel ❑Other _________ Number of living units:---.?____-- Number of bedrooms g ( 4',10 ---Garbage a Grinder ---- ------ Lot Sze ----------------------------------•-:•-._-• Water Supply: 'Public System and name -------------------------------------------------------------------------------------- Private Character of soil to a depth of 3 feet: Sand [] Silt❑ . Clay ❑ ..Peat❑ Sandy Loam Clay loam E] .. ,� . Hardpan E-] Adobe-E] Fill Material Ma__ If yes, type ____________________:____ N � (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) 4D- NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is availa a within 200 feet,] �! i51 PACKAGE TREATMENT [ ] SEPTIC TANK[ Size----------------------------------------- ------ Liquid Depth ..__--.___________________ Capacity --- --------------- Type -------------------- Material---------------------- No. Compartments ---------------------- Distance -----_----- - --Distance to nearest Well ____________________________________Foundation ___ ----------------- Prop. Line ______________________ LEACHING LINE [ ] No, of Lines ___________ _ ______ Length of each line----------------------- ___ Total Length -----------________-________ 'D' Box --- -------- Typ Filter Material --------------------Depth Filter terial ----------------------_----......._...--.. Distance to nearest: ell -_--------------------- Foundation __-_______ _ Property Line -------------- ......... � SEEPAGE PIT [ ] Depth -------------+ iameter _______________ Number ---.--._____c_________ ----- Rock Filled Yes El No ❑ ] Water Table Depth -------------------------------------------Rock Size --------- ------------•----•---- Distance to-nearest: 11 ____,_;'-*_____________ _ ----Foundation �- --------.---- Prop. Line ---------------------- { `•.3w, ta _.4 %' :'.i 1 REPAIR/ADDITION(Prey. Sanitation Permit -------_ ------------ ----------------- Date ________________ _.___-_____-.._-) { Septic Tank (Specify Requirements) _ -� -_----_-----_7---`--c--'i --n---S---_-_--�---------------_-_-_---1-----!-^- Y ------•---------------------------- --- --------------------------- _ --- s Zisposal Field (Specify Requirements) ------ - rr ^J.-..------77 61-17-7 AJ_IV� ---------;!5 ��--------- k -:- x ire Io------PHXF�r- � _ . � 0----14,x ---- t- r-.(Draw_existin.g and required addition on reverse side) I hereby cerfify'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 they San Joaquin Local Health District. Home owner or licen- sed agents signatire,certifies the followin _ _ "I cerci the` er orm a of the ork for which this permit is issued, I shwr'll not employ any person in such manner as to be m ub] to'-Wo ma 's Co ensation laws of California:" j Signed -- Ovrne� L BY Title _I, ------ --�------------- -------------------------------------- (If other than owner) TL!kA FOR DEPARTMENT-USE-ONLYLICATION ACCEPTED BY _----- ,__-1- _ -'0-------- ----- DATE __...--------------------------=------------------------------ - LDING.PERMIT-ISSUED—=_:_"y ='DITIONAL COMMENTS _ -----------------'-_-- .., l * - a - -- s . . ---------- ----------- _. _.._ . . --------------------------------------------- -- -------- -- ----------------- - - --------- - --- --------------------------- ------- - --- ---- ------ -- ---- - ------- - - ------------------------------------------ T —}� `] Final Inspe Date __-- '^ p 'f� ------- ------ --- SAN JOAQUIN. LOCAL,HEALTH DISTRICT E. H. 9 1-'6$ Rev. 5M