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FOR OFFICE USE: -_ APPLICATION FOR SANITATION PERMIT ---------------------------- (Complete in Triplicate) Permit No. _ �-------------- ------------------------------- i -�=73 ______.___________________ 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 made in compliance with County Ordinance No. 549 and existing Rules and Regulations. JOB ADDRESS/LOCATION t=w -: _c q-'D---------�--`---7 t7- --------- ----1� CENSUS TRACT Owner's Name -YttEt - = Phone y -�-------1--�_�_ . . ------------------------ Address -------mal ----------1M_A-f1L.A__k_N---------I V�e '---- ---- City ------: 1V_Le:1�, Contractor's Name -__C VV I'k. 1_T- AE'_L?______Z-C' - -------- -.-------.License # __2S7`t±!_73--- Phone" '("U_ a Installation will serve: Residence Apartment House E] Commercial :❑Trailer Court l❑ `Motel ❑Other ------------------------------------ --- Number of living units:-.---.I------ Number of bedrooms _______Garbage Grinder ----------- Lot Size -------�S____ _ r'� _'T------ Water Supply: Public System and name ------------------------------------------------ -------------------------------------------------------------PrivateX Character of soil to a depth of 3 feet: Sand'E] Silt'❑ Clay ❑ Peat❑ Sandy.-Loam*9 Clay Loam C) 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.) NEW INSTALLATION: {No septic tank or seepage pit'permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK ''.' Size_/iP__' ......4__ __________ Liquid Depth _-_- .................. Capacity/Avlp-4558.Type.,-=____ •__________ Material .No. Compartments f. L ' = . may ,. =Di'stance`to nearest -Z ." I ----- ------= Foundation---------- Prop._:___- Prop. Line -------k5............ w LEACHING LINE No. of Lines __.___.,3_ __________ Length of each line--------._..O__i___.__ _ ! ___ Total Length ._ __ �___-____ -0_ d 'D' Box ..___�_____ Type Filter Material _S�-��l�.Depth Filter Material _________/£�" Q___________________________ Distance to nearest: Well :_, .......... Foundation -- J-0_............ Property Line _____�.... SEEPAGE P1T [+] Depth ____ -------------- Diameter ----------------- Number ____________________________ Rock Filled Yes ❑ No I❑ 3 Water Table Depth ------------------------' ------_----Rock Size ---------------------- -- Distance to nearest: Well '_______________________________________Foundation -------------------- Prop. Line _______.__. REPAIR/ADDITION(Prev. Sanitation Permit ------------------------------------------- Date:_______-__________-___-_________ ) Septic Tank (Specify Requirements) --- ---------=---a--•-----------~------------------------------- :`-------------------------------_----------------------------- Disposal Field (Specify Requirements) `----------- -----------N--c—C-0---- -- ------cS -S-rC" 1--------------------------- ----------------- ------- ------- ----------------------------------------------- -------------- ------------------------- ----------------------------------------------•------------------------- i ---------------- -------------------------------------- ---- ------ ------------- ----------- (Draw existing and required addition on reverse side) I hereby certify that -have prepared this application and that the work will be done in accordance with San Joaquin County Ordinances, State Laws, and Rules,and,.Regulotions of,the San Joaquin Local Health District. Home owner or licen. sed agents signature ter es the following:i "I certify that in the performance of the work fo which this permit.is issued, 1 shall not employ any person in such manner as to become subject to Workman's Compensation la4ts of California." Signed "YL.T !-E !� S' :�+t} �2.�.; /N Owner y A *h � ----------- ------ -- --=.----- ~.-`. Title ------------- ----- -------- --------- --------------------------------- (If ---- (If other thdn:owner) ° FOR DEPARTMENT USE ONLY APPLICATIONACCEPTED BY ---------------------------------------------------------------------------------------------------- DATE ------------------------------ BUILDING PERMIT ISSUED ---------------------- -- ---DATE ----------------------------------- ADDITIONALCOMMENTS =----------------------------------------------------- ----------- --------'-----------------------------------------=•-------------------------- --------------------------------------------------------------------------------------- ------------------ -------------------- ------------------------------------------------------------------- - -------------------------'--------------------- -- - _'---------------------------------- -- -- - ------- FinalInspection by: -------------------------- ------------------------------"---------------------------- -- -- ----------------pate ----- - A - ------------------ SAN JOAQUIN LOCAL HEA (STRICT ;> E. H. 9 1-'b8 Rev. 5M