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FOR OFFICE USE: FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT I ------------- ------------------------- -------------- Permit No.;Yx-9573 (Complete in Triplicate) --------------------------------------------------------- Date issued .Q._t --.-----_------------------------- This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and,install the work herein described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATIONg -----------------794?1 fF4`---- --------------------- - --------.CENSUS TRACT---------------------- -- ....... Name--- 1 + �. ¢ ------------------------------------ ---_ ------ Phone-------------------------------------- Owner's. . 17 Address,--------- --- -------------- -- - ------------------- -- - - ------ ------------ ---------------City ----------- Phone-4.6' --------- Zip Contractor's Name L > 3 :e�' l+$�A9 /1'&4 --License #_-� Phone_ F� - .� ¢�r Installation will serve: Residence Apartment.House.❑ Commercial ❑ Trailer Court. ❑ 5 „ Motel ❑ Other = ------------------------ ---- ---- Number of.living units:.----'j- _---Number of bedrooms_._-__�---Garbage Grinder------------Lot.Size1fQ_,kAs*J_ 5 ��`->E��--��'-------- Water Supply: Public System and name#- -----------------�::-- . -----------------------.- --- -----------------_.-.. ---------- -------:. -------------- Private Character of soil to a depth of 3 feet: ' Sand ❑ Silt❑ Clay ❑$ Peat❑ Sandy Loam Clay Loam ❑ Hardpan 0 Adobe Fill Material----------.-If yes, type.---_------ ---- -----_------- (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,) w, e' PACKAGE TREATMENT SEPTIC TANK [ jSize--- - _�____-- -4 -do- ----------Liquid Depth-__- __.- Capacity 'TYpe ==----------- ..Material--- ---------- ---------No. Compartments- --------'�--`-------------------� 40-- � Distance to nearest: We .-.-- -®. `t-----------------------Foundation------�. ------,-------Prop. Line----A_ ----------------. LEACHING LINE ['] No. of Lines- --------------------Le 9th of each line.---------------:-.-.- ---------Total Length.------------ -- -------------i--� D' Box------------Type Filter Material--------------------Depth Filter Material------------------------------------------------------------- [: ,. . . i f Distance to nearest: Well_!-.---_------ ------------Foundation.-- -------------------Property Line--------_------_ h----.I- D, , " .. ., . - . «�� p � iometer-��.��i�__Number--•=---------------------------- Rock Filled Yes or . No' S� �G�& A Water Table Depth -- ----------------------------------- Wat -. F of - --------_-.----Rock Size----� ------ - --------'---------- -- I Et 0 t w Distance to nearest: Well------..�_gro---------------------- Foundation---40---I------------Pr6p. Line-IT--------------- REPAIR/ADDITION (Prev. Sanitation Permit#---------------------------------------------------Date----------------------------------------:k -) S Septic Tank (Specify Requirements)--=-----i kt j*---.9=4-44-40 '------------------------------------------------ -------------- --- ------------------------- _ Disposal Field (Specify Requirements) •'dam 9 ` �.AeArvo------------------------------------------ ------- --------------------------- ----------- - -------------- ------------------------------------------------------------ I ------------------- ---------- ------------- --- ----------------------------=-------------- + (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 licensed agents signature certifies the following: t "I certify that in'the performance of the work for'which this permit is'issued, .I shall not employ any person in such manner as to become,4"OjtNt to.„Workman'_ pensation laws of California.” I -_Owner Signed--- ----- ------ ----- ---------------- ----Title----------- ------- ----------------------------- BY ` ----- r (Lf other than owner( . i FOR DEPARTMEN SE ONLY APPLICATION ACCEPTED BY--- ------------------------'---DATE.--9 -------- -------------- DIVISIONOF LAND NUMBER ------ ----- ----- ---------------------- -.-------DATE .-------------------------------- ---- -------- ADDITIONALCOMMENTS------------ ---- ------------------------------------------------------------------------------.. ------------------------------------------------------- ------ --------------------------- ------------- ----------------------- -----•------------------------------- --------------------------- -------- ----- -------- -------- -------- -------------------------------------------------_ ----------- - f Final Inspection by:----- ---------------------- Date f r== __F& EH 13 24 SAN JOAQUIN LOCAL HEALTH DISTRICT F&5 21677 REV. 7Z 3M