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FOR OFFICE USE: ! �� r/.290 APPLICATION FOR SANITATION PERMIT ' -- --- ---- -------------=------------- -- - (Complete in Triplicate) Permit No. __ -_ - -`` ----------------- " ' i 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 ad axis Rule and Regulations: r 7 JOB ADDRESS/LOCATION /_;.2-1_0....... 4I- /�° e1------ o r ' ------- - CENSUS TRACT ------------------ Owner's Name --- �J° b ------------- --r-----. ------------------------ ----- --------Phone -------------------•-------------•- Address ,-- u� �f' � City --------------------------------------------- ----•-----------------•------ � 1�fi �k � Contractor's Name --- Cat�k Y r-------------------------------------------- --------.License # --------- ------ Phone ------ ----------------------- Installation will serve: Residence [�_Xpartment House❑ Commercial ❑ iler Court [ y617 Motel ❑Other �l� ur_ Number of living units:_ /_ -".___ _._ Number of,bedrooms __ ______Garbage Grinder ------------ Lot Size --, .-- !--------------------- + Water Supply: Public System and name --------------------------------------------------------------------------- - - Private 2 , Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Gay ❑ Peat❑ Sandy Loam [Clay Loam ❑ P Hardpan ❑ Adobe❑ Fill Material ------------ If yes,type --- i (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 flank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT J ] SEPTIC TANK [ ------ Liquid Depth _____-..--- Ca acit D-r2_----_ Type _ _ _ e_ Material__ rzc/^e - - No.. Compartments P Y -I-� YP 'rej� --- E.� ` \ i Distance to nearest: Well _0}Yet'_ ---______________Foundation _.___ �---------- Prop. Line ____-__ LEACHING LINE [ ] No. of.Lines �----------------- Length of each fine--------JK-6------------- Total Length :--�V-0-..-------_-_-• Y __D' Box, :_ T e Filter Material � �_ se th Filter Material 1.9 - Distance to nearest: Well ___b_Y'1� __�- Foundation f -�__.__.---- Property Line ----- ________________ SEEPAGE PIT [ ] Depth F -------- Diameter ----- ---------- Number ____________________________ Rock Filled Yes ❑ No i❑ WaterTable Depth ------------------------------------------------Rock Size -------------------------------- Distanc a to nearest: Well ----------------------------------------Foundation -------------------- Prop. Line-------------_------- i REPAIR/ADDITION(Prev. Sanitation Permit# -------- ----------------------------------- Date ------•-------------•--•----------) SepticTank (Specify Requirements) -------------------- --------------------- - -------------------------------------- ------------------------- _- --------------------------- �i Disposal Field (Specify Requirements) --------- ------------------- ----------------------------------------------------------------- --------------------------------- l ------------------------------------------------------------------- --------------------------------- ----------------------------------------- ---- I --------------------------------- -------------------------------- y (Draw existing and required addition on reverse side) I hereby,certify that I have prepared this application and that the work will be done in accordance with Seri Joaquin County Ordinances, State Laws,! and Rules and Regulations of the San Joaquin Local Health District. Home owner or licen- sed agents signature certifies the following: "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 becom subject ompensation laws of California." Signed - .. - - - ----------------------------------------- Owner , By ----------------------------------- ---- --- ---- ---- ----------------------------------------------- Title - ------------------------------ ---------------------------- (If other t an owner) DEPARTM NT USE ONLY I fi N �:_ (GATE -----/`,�-G -G APPLICATION ACCEPTED BY ___._.__ _____ Gf ___._______ -- __:--------- APPLICATION PERMIT ISSUED ----- --------DATE --------- ------------- ----------- ADDITIONAL C?MMENT �__ _ _ / '- -------------------- --------- --- ----- I � -�! ----------Date _ ------ ------ Final Inspection bY: ---- ---- - � - --------- ---------- - -------------------- - SAN JOAQUIN LOCAL HEALTH DISTRICT i E. H. 9 1-'b8 Rev. 5M.