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FOR OFFICE USE. 7 - • b a APPLICATION FOR SANITATION PERMIT ----- ------- _ k. •. Permit No: -.---_-^:- ----- . a (Complete in Triplicate) ---------=---------------------------------------------- i�. ------------- This Permit Expires 1 Year From bate Issued Date Issued --__�'_ Application is hereby made to the San Joaquin Loca�_Health District for a permit to construct and install the work herein described. This application is made in compliance w th County Ordinance No. 5.49 and existing Rules and Regulations. - + t JOB ADDRESS/LOCATION - "___ _ ___ EA�A - -D------------ ----- -----------CENSUS TRACT _- . Owner's Name --------E ---- -FU-R`S A-D_a ------- - ------ -----------------------------------------------Phone ------------------------------------ Address ------ ~L -------- Q �- - "` Cit -M-- -c1q------------------------ Contractor's Name -- D,9/Y--------------------�; ------.License # ------------------------ Phone Installation will serve: Residence❑Apartment House Commercial.[]Trailer Court ;0 Motel ❑ Other ----Dus! !---------------- Number --_----_- _Number of living units.-_2_ '-_ Number of bedrooms - -_-__-Garbage GrinderA! : Lot Size Q- -- ------------ Water Supply: Public System and name -------------------------------------------------------- ----------------- -------------------- -------.Private Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay .❑ Peat Sandy Loam, Clay Loam Hardpan.-E] Adobe 0t•Filf Material Nft"' If•yes, type `--- ------------ ----- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. rust be. placed ion reverse side+ NEW INSTALLATION: {No septic tank or seepage pit permitted if public sewer is available with intk0 feet,) . [ ]u! Size- ri.....~;M____�..------------ -- � �aid_ct tept PACKAGE TREATMENT h ---- i . ( ] SEPTIC TANK' V ICapacity ------------ E -_-�; yp� =` =.. � �Illlaterral ------ Nab -,Co pa?toren#s�------•----•-•=-•-- i Distance to nearest Well e!- _--- ----------- --Foundation --- _ Prop. Line.--------------------- . LEACHING LINE E No. of Line= -k t---_-- Length of each line ------ - ------_-- Total Length - -- --_-_f-_-__-_-_--_-__ ' D' Box -.- --------- Type Filer Material ----------- -------'bep_�`F Ii r Material -------------------------------- t-"- ---•- 4 ' Distance to, neayest:�lNll - v:� Foundation - -Property Line ------.-- --•----•: �t SEEPAGE PIT [ j Depth _ .-.----_ -- Diameter Number,° ___ ----_- Rock Filled Yes ❑ No .❑ Water Table Depth ------------------------------------- 3-- Rock Size --------- ---------------------- I------------------ - Prop. Line ------------- t -- --- {a� : Distance to nearest: Well ----------------------------------------Foundation __-_.___ REPAIR/ADDITION(Prev. Sanitation Permit s# ------------------------------------- Date: ----__-_.__--._._-__-_--_---_) E Septic Tank (Specify Requiremerits) ------------ [- T,--/-- 4 --------{ --------- C FST----jW-Ala.. ------ ---------- ---- Field (Specify Requirements) At------------�j6--f!------W-(-I)�------1.1��}G4-----iJ1V-E �1 dr 1Q ` X.-- ---------�_ 3_ �P-.�..: _�. ---- -I----------------------- ----- ------ ---- t ` Draw exist•n `?nd,re uirped.addition-o reverse side _ I hereby certify that ! 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 bistrict. Hosie owner or licen- sed agents signature certifies the following: "I certify t 'n he perform ce-of-the-work-far-which-this-permit-is-issued,-1_shall-no"mp y any person in such manner as to beco biect to Wor an' Compensad n' laws of California." Signed --- - -- ---- --------------- - -- F g - ------------ - --- -- Owner i i BY - -=-------------------- Title ------ ------ -------------------------------------_-A--------------- Ilf other than owner) 1 i FO, .DEPARTMENT USE ONLY APPLICATION ACCEPTED BY -------I--- ----------------------------- -------, DATE -----7!d3-1-7-- BUILQIIVG-PERMIT`ISSUED ., . �„------ ------------------- . �" - 4 ATE _�.ifs ADDITIONAL COMMENTS ------- _r i, }_� % - i c:- --------------------------------------------------------- _- -------- -- -------------------- - ---------- ------ - ------------------------------------------------------------------------------------------------------ ---------•--------- - --- Final Inspec ' -------------------------- ------Date ----- -7------3--4 - - -- t SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'b8 Rev. 5M