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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No. � ,� - " {Com lete in Triplicate) This Permit Expires 1 Year From Date Issued Date Issued Application is hereby made to theSanJoaquin 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 e ' g Rules a d Regulations: 6in .��.. ..� CENSUS TRACT - JOB ADDRI=SS/LOCATION _��1�-_�J---- -----�� ----- ----- ----Phonep'Sr'��f kl r�z_T :' Owners Name --- - �----�-------------��---------------------- -------:__--- - ---- -- - Address --------l--S---- z ----� -- ------•----- - - - ------------------ CiiY ` �1/'` Contractor's Name __.__-_ _ :_ _ _ .t'� -`� _License # - 5� Phone -`�--- f°6� ��1JL7 -�,�_,�------- �'�� ---•---•---- Installation will serve: Residence ❑ Apartment-House-[] Commercial ❑Trailer Court Motel ❑ Other ---- oe� 'l { /��' 7�i'.+ r g`b•CI Pav ' Number of living units:___________ Number of bedrooms ------.-----Garbage Grinder ------------ Lot Size _____/-- -------------- --------- Water Supply: Public System and name --------------------------------------------------------------------------------------------------------------Privat ----------------- -----------------------------------------------------------------------•------------------Privat Character of soil to a depth of 3 feet: Sand ❑ Sil xClay EJPeat❑ Sandy Loam 0 Clay Loam— . k • Hardpan ❑ Adobe A Fill Material ------------ If yes,type ---------------------------- r (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 I ] Size----------)0 0b ellljr-IX.--Jr Liquid Depth ..... .................. Capacity ___1jD.b_i'.2_ --- Type �-�';_�_�:s�'Mafien � al----P-�- -------- No. Compartments ---- ---•-----------• �. - Distance ito nearest: Well ------------------------- Foundation Prop. Line ----- --------•rte LEACHING LINE [ ] No. of Lines -------S-------------- Length of each line-----/_0.4___--____------- Total Length f`_ aQ_�_.....-__-.-- 'D' BOXP-e ---- Type Filter Material ft17`-.�__.�64pth Filter Material -------- -------------------------------- Distance to nearest: Well _�-�'�`__ �-� Foundation _b_Y�r'---I -____ Property Line ___16d`_____________ M ! J SEEPAGE PIT [ ] Depth '' _ ,�- ------ Diameter _1 -_.________ Number ______ ----------------• Rack Filled Yes No >D f r Water Table Depth -----------�" Rock Size -- ?L Distance to nearest: Well ------4_ if:� e _�__1 __._____...FoundationProp. Line ---1_6.!------------ REPAIR/ADDITION[Prev. Sanitation Permit# -------- ----------------------------------- Date --------_------------------ 1 f Lf_-_r'___ _____________.._----_________-______________.__ _ Septic Tank !Specify Requirements) ----�---- �----'�-----�`'�-^Y------------------------------------•---------�-_---- - . Disposal Field (Specify Requirements) ------------ - -- - - -"'=----- --- d---------- --------------r � ---------------------------- --------------- F - ----------------------------~�' -----------------------------------•-------------------------- --------=------------------------------------------------------------------------------------------------------ -, ------------------------------------------------- --- $Draw existing and required addition on reverse side) T'er�, I hereby certify 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 the.San Joaquin Local Health District. Home owner or licen- sed agents signature certifies the foll®vvin§ "°. # ' :� "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 laws of California." Signed -- ------- g^ s,f_. ._r---- -------------------- Owner `�� _ .. ` % ' � x� -'TiNe � -------------------------- - l; (lf other than owner) I Y ] DEPARTMENT USE ONLY F APPLICATION ACCEPTED.BY - - -- --------------------------------------------------------------- DATE --- ------------ BUILDINGPERMIT ISSUED - - - -- ----- ----------------------- ------------------------=--------------DATE -f--------- ------------------------- ADDITIONAL COMMENTS �` �'!f --- - ---- �� ---r------------------------ Z------- ------=--------------------------- ---------------------------------------------------- --- ------------------------------- �_'- -------------------------------------------- ------------------------------- ----------- -- - ---------------- ------ --------------- ---- ----------- ----------------------------------------- -- -- - -- - - - - ------------ -- -- - -_ , _ Final Inspection b A------------------ - --- ---------- ------------------------Date --- ------ -------- SAN J AQUI LOCAL HEALTH DISTRICT E. H. 9 1-'b8 Rev. 5M.