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FOR OFFICE USE- --------------------------------------- SE: APCiCATION FOR SANITATION PERMIT ' " 70 d �_ O ------ ------------- - ------------------------ -y----- Permit No. ---- ---�-----(Complete in in Triplicate) This Permit Expires IYear From Date Issued Date Issued <1 011/t�31rklt_Jt Application is iereby made to the San Joaquin Local Health District for a p6rmit�to cons ructanti install fine work herein described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations- -19N egulations: JOB ADDRESS/LOCATI N .__ Id's RJ__Pf---------F --------- -CENSUS TRACT ----- ----- ... ---- Owner's Namej ----- - -enj n �Q -------- ------------------- ---------- --------- --Phone 7=_0.1 Address --------/- --------------R-1-P-0 -------� --------------- City pQ Q f Contractors Name ------- [.N1�-------- ` = License # ------- - ---- Phone-`5_7 - __��--. ., I Installation will serve: Residence P14artment House❑ Commercial-❑Truil&0� 5rt I❑;� � 1.:0. N IV\iMWteF❑ Other ------------------------------------------ --l�g'rber of`living units:_-__ -__ Number of bedrooms Garbage Grinder Nd----_ Lot:Size __ICR_ RC� ___.----- ----------- Water Supply: Public Systemiand name ---------- ---------------------------------------------- -- - - Private ElCharacter of soil to a depth of 3 feet: . Sand'❑ Silt E] Clay E] ..,Peat 0 - Sandy. ----•--:Loam Clay-Loam;❑ Hardpan 0_ Adobe'❑ Fill Materiae _ 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-orQeepage ,pit permitted if public• sewer is avoilable within 200 feet,) �[ PACKAGE TREATMENT I ] SEPTIC TANK [ ] Size-----------------�------------------- --- ...:..Liquid Depth -------------------------- 1 Capacity�.ir- -------- Type ----------------- Material------------------- o- icompartments ----------------- . Distance-to-nearesf: Well,i ,_ =-"-------------------------- Foundation ___-- _-- --f___--_-- Prop. Line -----------------_-_-- J � LEACHING LINE [ ] NO., of Lines _____-.---- _ ength of each line------------------- _.__ Total Length _________________________._ D lio'x ------------ Type Filter aterial -------------------!Depth Filter M teri a l ------------------------------------------•- ' 4 Distance to nearest: Well-- �_------Founds,ion ------------f---- ______ Property Line ---------_______________ 1 SEEPAGE AIT [ ] Depth# _________ _____ ___ Diamet r - Number ___.__,—.--____-i---- _____ Rock Filled Yes E] No i❑ •J..t- � � ti 1-.i�r 1�f C tt Wate�l.Table Depth - - ---- - , - . . --:,Rock Size --------- -------I----------.--- p - ---- --------------fix:-, Distance to nearest: Well ----- ----------------------------•--Foundation -- - -------t--.---- Prop. Line ----------•.--•--___-- REPAIR/ADDITION(Prev. Sanitation Permit# _.---- -----------------=--------- Date ------- .---,--- ----------------] 3 SepticTank (Specify Requirements) ------------ --------------- ------------------------ -------------------------------- -------------------..---------------------------- 1 � � Disposal Field (Specify LRe�quirements) ------Qfc�T- QSC-----/ ----.-T/4�Oi----------- ------IY --------© ------ i rI� � x - --- ------------- ------- lt 4 1 l __- _ .,._. -- -- ] ------------------------- ------------------------------ ---------------------------------- -_ ------.- --=- ==- j I_------- d addi (Draw existing-and require tion on reverse side) , I hereby certify that I have prepared this application and that the �Iork will be done in accordance with San Joaquin County Ordinances, Statei La s, and Rules and Regulations of the San Joaquin Local Health Distri t. Home owner or licen- sed a4beme ture certifies the following: W. 4 "I cethe pe or once of the work for which this permit is;issued, I shall not employ any,person in such manner as tobject to W iman ComCompensation laws of California 1 p „ Signe ^� -- ----- -- ----------- -------------- ------------ Owner ; L ! ------ ------------------------------ Title --------- --------------------------- other than owner) ' FOR DEPARTMENT USE ONLY ] { APPLICATION ACCEPTED BYt_ =Q - -----------. DATE ----Z= O __ BUILCi1NG�ERMIT-ISSti1ED . _-- - -_.-- _--�-•- ----- ---------- ------- ADDITIONAL COMMENTS - --- --- -------`',. ----- !`r r°, s•_. # ------ � to `i-----------------------------------'------------------/_)v - -) - . . , --------------- -- - --------- --------------------------------- -------------- ---------------------- - = - ----- ------ - - - ------------ --------- ---------------------- ------ FinalInspe ---- ------ ------- -- -- - --------•---------------------------- ----- Date -------- --------------- --------- - ------- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'08 Rev. 5M u