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FOR OFFICE'0SE l `_ x APPLICATION, FOR SANITATION 'PERMIT - - ----- ---- - :. Permit Na.e (Complete,in Triplicate) ;. c . This Permit Expires i Year From Date Issued Date Issued // . -------- ------ ----------------s - Application is-hereby,;made to the San Joaquin Local Health District for, ciermit to construr�4, and,;install the#.'work herein described. This apphcationAs 'made in compliance with County Ordinaneel.No.,549 and existing Rules'and eguldtions: *JOB ADDRESS/LQCATfbN ---I_ I.7 7 ---�� __ _ --- -Q-1 ------RD_ ,� Y _�lfT CENSUS TRACT Owners Narne t l-I_Fe 5bR l ------------------------------------ _. . h e _-- --- ------------------------ I _,j- - - SQA � Address {.I-_I- 747 h ' L Q -------- -------------- --. City, � g ------------------ - - --- - Pone ---- � t f Contractor's Name __0V__N F_Z=R------} - - : ' License # Phone ------- ------------- -------------------------- -------- will serve: a Residence ❑Apartment House E]/Commercial;❑Trail r-Eoa+�t ,�� ! t _ i i, Motel ❑Other -----_. -------------------------- 0 �__Garba /� Number of living units:----._---- Number of bedrooms ._. ge Grinder ..�\/.Sl__ Lot Size _ ht_CR_ m�_��_"�_'.--------- I iL Water Supply: Public System and name -A--------- ------------/ •----:-------------------------------------Private Character of soil to a depth of 3 feet: Sand'[] Silt[]/Clay ❑ Peat❑ Sandy Loam E�-�Clay Loam ❑{ Hardparti ❑ Adobe 'D Fill Material ..N.f� _- If yes,YYPe ----------------- { V {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,) r r PACKAGE TREATMENT [ SEPTIC TANK .} Size------ ' . _j ' ---------- Liquid Depth --- Capacity .. _ f ' ; P Y 12-0-0----- - -- YP � fi ^�` .. Founds C` No. Compartments Ca acit T e - - �.Y�� Material__�4� E -- -- '- - � .lQ�on- oTotal Length ------�--�----_=------••- \� < ; 1 i -- Distance to nearest: Well p. line I LEACHING LINE No. of Lines -------/ --- Length of 'eqh line.*__ ; g r �_ ---------- :S �l F I i q 'D' Box [11_x-._-- Type Filter Material Q:'.i ._.Depth Filter Material ----J F __. �- :: _ n ------------- Distance to nearest: Well _---_OV-,---. Foundation I 1E�.�`_ Property Line. SEEPAGE PIT j Depth Diameter __-._.-.._-'. IIlumber -- _.-..__..._ _ Rock Filled . Yes9 E] 1 No C1Water Table Depth ------------------------------------------ ---Rock Size -------------------------------- I � Distance to nearest: Well ------------------ •--------- ----------Foundation.------- - -------------------- Prop. Line --------f------------- REPAIR/ADDITION-(Prev. Sanitation Permit s# _.__-----..-.-- ------ ------- Date ---------------------------------- Septic _______-Septic Tank (Specify Requirements) -------------------------------------------------- ---------------------------- -------------:-----------------•--------------' -----=-- Disposal Field (Specify Requirements) ---------------------- ------------- -------------------------------------------------------------- ---- ----- --•----------- FT •--------- d required addi E Drawexistin ( ---__�- -------- --_---- -_---- 9 re uq • !tion on reverse side) 1.hereby certify that I have prepared this application and that'the' work will be done in accordance with 15an i Joaquin County Ordinances, State Laws, and Rules and Regulations of the i-San Joaquin Local Health District. Home owner:or Hcen- sed agents signature certifies the following: "I certify thdF in the performance of the work for which this permit'is issued, I shall not employ any person in-such manner as to becomes ct t Wa a�ompensoon laws of Californra." Signed' bwner Be = ~ - ---- --------------------------- ---------------- �itle Y: r I (If ofher than owner) -'� W + FOR DEPARTMENT USE ONLY } IOACC Y - --- - ------------------ - ---------- ----------- ---------------------- DATE --APPLICATf--- __ --- - -----. -- BUILDING 'PER It�ISSUED DATE - __ I --- " _ ADDITIONAL COMMENTS �___ .. ---------- --- - -------------- ------ --- -- --- ..- --- - --._ ry } FinaLlnspe bY' ----------------- '------=- Date 1. -/ `` -------- �r' i - SAN JOAQUIN LOCAL HEALTH DISTRICT E..H. 9 1-'66 Rev. 5M. {.,