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FOR OFFICE USE: FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT --- - --- ---------- --------- -- ----- (Complete in Triplicate) Permit No.-____--_ �-: 1 Date Issued.a_/6_-�1 ______________________________ ___.______ ------ This Permit Expires 1 Year From Date Issued t Application is hereby made to the San Joaquin Local Health District for a permit to construct and nstall,fhe work herein described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: n 940 Flower - JOB ADDRESS/LOCATION--- ---- --- ---------;---- --- --------- --- ---------I--------------------------------------- ---------CENSUS TRACT---------------------------------- 7 Cwner's ---------- -------------------- Owner's Name- ----- ---- -------Orv-il-5.chaaffer ------------ ------Phone---- =------------- Bird T. A Address- ' ----Cit Zi -- - Y- ROTO Rb�TE� -S!✓WER $'i1'i�lVT�iE � 27159 - ---- - - - 140=25-1&-------------- Contractor's Name------------------------------------- ------------------------------------------License #---------------- -----------Phone- Installation will serve: Residence ® Apartment House.0 Commercial ❑ Trailer Court ❑ � Motel ❑ Other--------- -------------------- -------- 1 s 2 no 75 by 150, - Number of living units:___--______ Number of bedrooms_:_______-__Garbage Grinder__._._.__4ot Size_s_-__-__--__ �'.___________________ ------ Wafter Supply: Public System and name------------------ --------- _ ` __.______}_______________Private ® j :... 1 Character of soil to a depth of 3 feet: Sand ❑ Silt ❑ Clay ❑ Peat ❑ Sandy Loam ❑ Clay Loam Q Hardpan ❑ Adobes] Fill Material._.__._____If yes, type___`--------- t t 4f - (Plot plan, showing size of lot, location of system i?n 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 [ ] t Size__________ _ _ _ : __ __.__ __________ ____ _ __:._Liquid Depth.--------------------------- � l F Capacity--------------i---- Type ----------- -----------Materl'al---------- i No. Compartments- '-- -------------- ----------- Distance to nearest: Well....... 6_,=-------- ------- --. --Foundati'on----------- -__ r_-_--_=--Prop.Line-------------.------------ - LEACHING LINE. [ ] No. of Lines----------------=-.--- ---- Length of each line-- .___ ___ __ ______Tota Length. ------ ---_ ----------------d D' Sox.-- Type Material Depth Filter Material -`----�-- ---------------------------- -- Distance to nearest: Well_, ---- -Foundation---------------------------!Property Line__.------"-__-_.__.___- SEEPAGE PIT [ ] Depth � 1 ❑ -- n -:----Diameter__-----------------Number-----------------"------------._ t Rock Filled Yes Na Water Table Depth._`�---'---------------------------------------------Rock Size-------------- ----- -------------------------- . d Distance`to nearest: Well-J-----------------------------------------.Foundation----------------1__------.Prop, Line---------------------------- -'14 REPAIR/ADDITION (Prev. Sanitation Permit#_____________ ______.._ ------ Septic ------------------- Date t i - r-i t+ Septic Tank (Specify Requirements)------------------ --------------------- = - a.dL0'rof leach and 1 sump 24" by 2t3:' by 10'deep Disposal Field (Specify Requirements):----------------- = --- = - - - _.___f____________________ _ _ __ __________________________________.�__.____..._________ ________________._ i _________________________+_._-____.____.___..-__.__ --_-_•_------------------ ------------------ _________"_-__"_____________________________.___ _._ _.___._._______..___.___.____________.___.____.___ } " - _ (Draw existing and required addition on reverse side) zi I hereby certify that I have prepared this application and that.the work will be done in accordAance with San Joaquin County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District)Home owner or licensed agents � signature certifies the following: "I certify that in the performance of the work for which this permit is issued, L.shall-not--em ploy any'person in such manner as to become subject to Workman's Compensation: laws of California!1-'%'V. J. 7 t . Signed---- ------- -------------------------- ----- ---------- --- ---------------i :-. `�, Ci ner - �.. ( I. Estimator N ? BY-`----------- -------------'---------------------------Title----- - _-------------- ii of er than owner) t j I F R'DEPARTMENT USE ONLY! r APPLICATION ACCEPTED BY----- - _r -------- -------------- ;-- DATE -------- ------------ DIVISION OF LAND NUMBER:- - ------ ------ ----- ----- --------------- ---- --- ------ � _ DATE------- -----------� ADDITIONAL COMMENTS--- ---- ------ ------ ------------------- ------------- - --------k.-------------------------- "'` ------------------ --- -- -------- ---- ---- - .. __---- ---�------------ _________________________________________ __. .t.__,1, _ ______.__.___ ________ _____._.__.__________________________._______________.-___.___ ____ Final inspection by:_..-- '-' --- = Date a=A �, ti EH 13 24 fN � SAN JOAQUIN LOCAL HEALTH DISTRICT-E` t Fos 216776 3M A