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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT _ <br /> Permit No. <br /> 'Complete in Triplicate) <br /> -------------------------------------- -- <br /> --- ----- -------------------- --------------- This Permit Expires 1 Year From Date Issued <br /> Date Issued ._ '-- -y___. I <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein <br /> described. This application is made in compliance with County Ordinance No 549:10nd existing Rules and Regulations: <br /> n- 7 T7 - .-- - { _-- CENSUS-TRACT ------ - <br /> JOB ADDRESS/LOCATION ------3�=�5-- :•Y-e�t--�a�.4-------=---==---= -'r ------------ ---- ---------:---- - ---------------- <br /> Owner's Name -----Calif. Wat6r Sed''---CQ' ------------------Phone --4.64.x$311.---------- <br /> - --- ----------- - <br /> - Clt --SC4 950-5------------------------------ <br /> Address ---1.&02---E�.�i_'.-La.fa.y_et�t-e--�-�•-----�=-`-`-`=`-------------------� Y'---- - �-, { <br /> License # .-268-9513-- -- Phone 46.3-_Zg�8____.____ <br /> Contractor's Name -?3aa ' E.' s Sepo 'a't ----------- i <br /> Installation will serve: 1Residence ❑Apartment House ❑;Gommercial frailer Court ;❑ l <br /> I � R <br /> Motel ❑Other ------------------------------------------ t <br /> Number of living units:----------- Number of bedrooms`------------Garbage Grinder _.__- Lot Size .___________ ------------------------ <br /> Water Supply: Pjblic System and name -------------- ------- -R----------Cit -----` Y------------------------------------------------Private F-1Character oil a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat ❑"'i Sandy Loam ❑ Clay-,'Loam :❑ <br /> "Hardpan ❑ Ad'obe ® Fil! Material ______._.___ if yes, type*________________ <br /> !. C <br /> (Plot plan, showing ize of,lot, location of system in-Telation to wells, buildings, etc. must be placed'on reverse side.) <br /> NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) t <br /> -_ 8" <br /> PACKAGE TREATMENT [ I SEPTIC TANK'[: Size____2C_+x6-NK6-f__._.__-a__.___.---- Liquid Depth __________________________ <br /> ` 2400 gal so, cQncretEe <br /> Capacity T ----_--- Material- ----- ' ..__ No. Compartments 3 +V,t <br /> Distance--to-nearestr We11„ ___�-' _� --¢ Foundation 1fJ_-......... Prop. Line ..30-1------------ <br /> LEACHING LINE No.ro'f Eines __.-- -- Lent th/of ach„Iine � ( otal`teh' th � <br /> D'rBox ... Type Filter Material . _____2___-_--_--Depth IFilter Nlateriaf ________7.9'x________________ <br /> ------------------­---------- <br /> " -- _o --- Property <br /> Distance,tocnearesfi: Well ..______�-__ -- -�-Foundation 7 -.--_______ Pro er Line <br /> SEEPAGE PIT C] i Depth r_. _� ' Diameter 43-"-_-__ Number .--__3- t_.____a__------ Rock Filled Yes No i❑ N <br /> ,y <br /> Water Table Depth ----------9P-r-------- -------Rock Siz i7_ t1--------------------_-- <br /> Distance to nearest: Well ------- - ""----------Foundation) -30_1---------- Prop. Line 1�,!-------------'-'- <br /> .-.- e ---------------------------------- <br /> SeptY__.. <br /> REPAIR ADbITiON(Prev. Sanitation Pets)ri#��_O__-----------------------------------? . Dl�e ---------- *� <br /> — -- --r <br /> ic Tank (Specify-�Requiremen ,4 ;' p - -- - ----- <br /> Disposal Field (Specify Requireme ts) ------6() --Pitz--------4-F-'-'-X-2-3------------------------------------- <br /> ----------- ------------ - ---------------------------- ------------------------------------------------------------------------------------------------------------------------------------ <br /> (Draw existing and required addition on reverse side) <br /> I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin <br /> County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner or licen- <br /> sed agents signature certifies the following: <br /> "I certify that in the performance of the work for which this permit is issued, I shall not employ any person in such manner <br /> as to become subject to Workman's Compensation laws of California." I <br /> Signed - ----------- --------------------- Owner <br /> CV Contractor <br /> By ------ ------------------ Title <br /> (If other than owner] <br /> R . P TMENT USE ONLY <br /> APPLICATION ACCEPTED BY ._- -- __-- _ ----- --- ------ -------- -- ----- -----. DATE - .—_. .` l <br /> BUILDINGPERMIT ISSUED -------- ----------------------------- -------------------------- ---------------------------------------DATE ------------------------ ------------------- <br /> ADDITIONAL COMMENTS ---------------_---- --------------------------- ------- ----------- <br /> ----- ---------- -- -------------=--------------------------- <br /> ------- --- -------------------------r'� - <br /> ----------------------------------------- <br /> ---_-_ ---- - - -- ----- �_ --� ---- -- ---- - --_-__ <br /> ________________________________________________ _______ __ _ _____ _ _. _ J <br /> Final Inspection by. ---- -- -------Date <br /> SAN JOAQ IN LOCAL HEALTH DISTRICT '1 <br /> E. H. 9 1-'b8 Rev. 5M <br />