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FOR'OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Triplicate) -------------------------`--------------- -- -3_:f __---------------------- This Permit Expires 1 Year From Date Issued Date Issued -----:- -Y Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein I described. This application is made i&Acompliance with County Ordinance No. 549 and existing Rules and Regulations. JOB ADDRESS/LOCATION 2 ,. t�1- L'E_�I Q ------------------ --------------CENSUS TRACT _. .....---- Owner's Name ------------MR-R71.li-I �-----0------H_U_Bz�RT---------------- -= -- -------------Phone ------------------------------------ Address _.--------' 1'_VLj----- ---�- ---- LJ� o-N- ------------------------ City ------------------------------------------ Contractor's Name ..... _1l-'l.11_y[_E�' �-------------------- License # ------1---------------- Phone ---.-------------------------- Installation will serve: Residence eApartment House-[] Commercial:❑Traileit-o.urt ',❑ f Motel ❑ Other --------------------------------------------: Number of living units:-__.l_----- Number of bedrooms _;�=_-Garbage Grinder �*----- Lot Size _ CRZA -E----•-------- Water Supply: Public System and name _ _ ---- �4Private �/ =--------------- --- Character of soil to a depth of 3 feet: Sand❑ S' t❑ Clay ❑ Peat❑ Sandy-Loam-Z5`--JJClayioam ❑ Hardpan V Adobe ❑ Fill Material A_.Q- If yes, type -------].__-_-_____- � - -�- (Plot plan, showing size of lot, location of system in relation to wells, buildings,l etc. must be placed on rev-eside.) t NEW INSTALLATION: (No septic tank or seepogq pit permitted if public-sewer-is=avails 6le within 200 feet;l—_ PAC��KAGE, REATMENT I ] SEPTIC TANK f ] Size----------!_------------------------ ---' Liquid`Isiepth .``------.--;-----•------ - i\_-_ T , Material____--- o� �Cornpartme�ts w- --•��f Ca acit -- --- p --r'---------�---- %_ i _ I --------- Prop. Line ---------� ------ �`� !4----Distance rto--nearesfi:---Well - --- --- - Foundation Irl F' LEACHING LIFE [ ] No. of Lines _____________________ __ Length of each line;--_________--------- -- Total Length ----- D' Box Type Filte Material I _Depth Filter M terial _ -� Distance to nearest: Well ----------------------- FoAcition _'_--.-------------------------- ------ Property Line --------- ------_----- \[ I Depth _____________ ___ Dia eter ---------------- Number ------------ ----- - ---- Rock Filled Yes ❑ No i❑ Water Table Depth -------- ------------------------------- ------Rock Size ` ----------------------- �,�� Distance to nearest: Well -------------------------------_-Foundation --- Prop. Line ----------------•.•.-- REPAIRfA�1DIT.lON(Prev. Sanitation Permit# ------ ---------------------------------- Date __-____.________ .----------_._-1 ---- -------------------------------------------------------------------------:----------------- --------------------•------- - SeptiE Tank' (specify Requirements} _______.____ _ I Disposal Fief (Specify Requirements) -- � _ _ _lr - -- 1J�� ---------------------------- 11-VIS -1-A E --------------------------L 6FT1_C' �N�_ - y-I0--------------36-. �� W1 ,��----_ ---f N ---- , -XI-0 EP6_4 (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 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 following: It "I certify t tin th performanc thew rk fo which this permit is issued, I shall not employ any person in such manner as to bec su ' ct to Workm n Com ens i laws of California." Signed ---- - - -- -- ------- --- - - - --- -- ---------------------------.--- Owner B } ---- -- ------------ -------------------------------- t Title -------- ------------- ------------------------------------------------- ( (If other than owner) FOR DEPARTMENT USE ONLY -------- DATE ------2 �- --- 4 APPLICATION ACCEPTED BY -------- -------------------------------- BUILDIN_G—P_ERMIT ISSUED ------- _-- r _ ------ ------- D TE-.. _ ------------------ --- ---------- _YSADDITIONAL COMMENTS --------sem �!�blvl_✓�_1��-------J��r�-�.------J��R�1__�;�---ry�� _TEJf\ D.. --�1��.1� e EF ------------------- - - ----------- 1 :----- Z Final Inspectio - --------- 1 -)----- ------- - - -- - - ---- ---- ---=---------- -----------Date - --- -------4&----- -- --------------- SAN -------- - -SAN JOAQUIN LOCAL HEALTH DISTRICT F. H- 9 1-'68 Rev. 5M