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FOR OFFICE USE:.SE FOR OFFICE USE: -� APPLICATION FOR SANITATION PERMIT \. Permit No.-7 J /b3� (Complete\fn Triplicate) Date Issued-.a�-:.o�. .-7 ----------------------------------------------- -------- This Permit Expires 1 Year From Dote 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: k JOB ADDRESS/LOCATION_________________E.-5341+--g-;._MT11e-r------------------------------------------------------------CENSUS TRACT-. Owner's Name---F..-_Radxigi ez----I----------------------------I-------------- ------- -Phone.------------ -- ------------------------------------------------- ------------------------- 5344 E Mi.11er' Address------------------------------------ ----------;----------------- -------- _.City------------------------------------- -------Zip------------------------------ -- 1 4b5-2616 Contractor's Name---------------R4T-4--i3l80T1;R--SEWER--S_l"�-V-ICE----------------- - --License #-_.271539-----------Phone--.------------------------- .---- Installation will serve: Residence [!9 Apartment House.❑ Commercial ❑ Trailer Court ❑ 1 Motel ❑ Other----- --------- ---- - ---- --no -------- 60 by 100' Number of living units-----------------Number of bedroom s._-_-------Garbage Grinder.------------Lot Size--------------------------------------------------------- -_ Water Supply: Public System and name------------CALIF.---'WATER--IS—M------------------------------------------------------_-----------------------------Private �. Character of soil to a depth of 3 feet: Sand ❑ Silt❑ Clay ❑ Peat ❑ Sandy Loam ❑ Clay Loam ❑ Hardpan ❑ Adobe Fill Jvlaterial.-.--,.-.--.If yes, type------------------------------- - M k (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) i NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) i ` k ' PACKAGE TREATMENT [ ] SEPTIC TANK [ ] Size------------------------- --------- --..------Liquid Depth ----- ------------------- Capacity-------I------ -- ---Type Material-----------1------ ------------------------------ - No. CompPart�ents--------------->------------------ Distance,to nearesi_.W.el. l - ------------------------Foundation- ---------- ------------Prop. Line------- ----------------- LEACHING LINE [ ] No. of Lines. ------+- ---------------- Length of each line.--------- ------------------.Total Length.---.-,--------.---.. -_---.------------ 'D' Box.--)A-- Type+Filter Material--------------------Depth Filter Material--------------------------------- I --------------_-- --— Distance to nearest:;Well.-R____ ---__---.-----.-Foundation-----------------------------Property Line.-.----.---_-----------------__- SEEPAGE PIT [ ] Depth-__ --------- Diameter-___ Number-------------------_------------ Rock Filled Yes ❑ No WaterT'ble Depth------------------- -------------------------------------Rock Size------------------------------------- -_------ Distance to n�arest: Well----------i--------------------------------Foundation--------------------------Prop. Line-'-------------------------- REPAIR/ADDITION (Prev. Sanitation,Permit-# ----------------` - -------.-------------.----_---.Date.-------------------------------------------.1) Septic Tank (Specify Requirement;) --------- -� Disposal Field (Specify Requirements[;------------------INSTALL NEW 42" dza by 25'./iseepage pit andT, - hook to exi.sting,�drai-nsy Jam' : T -1-- --------------=------------------------ -- ---- -------------------------------------- ---------------------------- =; ------------------------------- ------ F (Draw existing and required addition on reverse side) t 1 hereby certify that I have prepared this application qnd that the work will,be' . done in accordanc*7 with San Joaquin County Ordinances, State Laws, and Ruler,+and Regulations -of the San Joaquin Local Health District. Home owner or licensed agents signature certifies the following: .1 "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 become subject to Workman's Compensation iawS%6f California." - o Signed-- ` ----- --- -- ----Owner By----- / - 1 ESTIMATOR _ --------- -Title----------------------------- ------------------------------------------ (lf other than owner) ; , FOR DEPARTMENT USE ONLY r> APPLICATION ACCEPTED BY-------�� ------ ------------------DATE.fX---- -- --------------DATE.--"-----y- ----- DIVISION OF LAND NUMBER.. _1 --- - --- -------------------------------------------------------------------------- ------------DATE----------------- ADDITIONALCOMMENTS------------1-------------------------------------------------------------------------------------------------------------- -------------------------------------------- ------------------------------------------------------ ------------------------------------------------------------------------- ---------------------------------------------------------- s ---------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------- Final Inspection by:- ?/.y?2 >% -----— ---------------------------- --------------------------------------------- Date -��---�- EM 13 24 SAN JOAQUIN LOCAL HEALTH DISTRICT F&S 21677 REV.