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FOR OFFICE USE: FOR OFFICE USE: APPLICATION.fOR SANITATION PERMIT ------------------------------------------------::-------- (Complete in Triplicate) Permit No.zK�4.-jr4.3A --------------------------------------------------------- Date ---.-_________.____..________________________ ---- __ This Permit Expires ] Year From Date Issued Application is hereby made to,the San Joaquin,Local-Health Distriet�for a permit to construct and install the work herein described. This aOplicat on`Fis am.ade)necom�pliance wi#h County Ordinance No. 549 and existing Rules and Regulations: t JOB ADDRESS./LOCATION--. v. ,_.� �."1----k1IV�------- - ---CENSUS TRACT ------ _ - .-__-- Owner's Name----C-'----- --- ----- ------------_------------------------------------------- --- ------ Phone�fct��_�r- .---- ------------ _ 1 �1'.E ------ _------------- ------- City -D��..�'."--ll/ Zip - - --- ---- Address-. 5 �. Contractor's Name = + �4 / / ,� ---------------------•---------------.license `r.- - ._Phone-5'Z��' �� / _07 Installation;will serve: v Residence Apartment blouse ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other---: -- ---- Number of living units:_-:-/--------Number,of bedrooms-,I-; _Garbage Grinder_. _ ._ __Lot Size . __ _,-d!/--- ------------------------- Water _______________ ____Water Supply: Public System and name--------------- - ---------------------_----------------- '----------------- - .- r=.-.--;-.,-.---_.-- -- ---------Private ❑ . Character of soil to a depth of 3 feef\ San l- Silt❑ Clay ❑ Peat:❑Sandy Loam ❑ l oam i -. Hardpan ;K AcIbbe E_J Fill Material------------If yes type__________________ ___._____ (Plot plan, showing'size of lot; location of system in relation to wells, building`s,'et mu It placed on everse side.] . NEW INSTALLATION:` (No-septic tank or seepage ;pit permitted if public <ewe Is a ailable with' 200 feet,] PACKAGE TREATMENT- [ ] SEPTIC TANK r4 Size_=_&+�o - --- f°_____________ ____Liquid Depth_ _.____._-______._-_.t---- Capacity __Capacity - --Type*4"14 Material r -----.`_No. ;ompartments------- f / � {� 4 f Distance,to nearest:Welff:. =_ _ __.___- ,- '�-.;- Foundation._____ d_.= _ y Prop. Line LEACHING LINE No. oof Linees �. _ __ _ Length of^ k°I net Toia! Length.__.___ 4_ :;�, ------ ,- - !�/{ D' Box-----^`•• Type f=ilter,Mate�iah_-- —Depth Filter Ma rial-- 1 - ------------ --------------- ------- -Distances to nearest; Well------- _ .__ � _. ouncl both- __... -----------Property Line------------------------------------- SEEPAGE ._ _.__SEEPAGE PIT Depthi/ �. 4.E iamete'r_,3 _ ___ er_ Z T__' Rock Filled Yes f No ❑ ' r ' Water Table Depth._ _ l j__-=Rock Size - --------------""-- IJ i iT Distance to nearest Well---- � ___ ' ___jFoundation___/6_ ' ________.Prop, Line__6.___'n------------ REPAIR/ADDITION (Prev. Sanitation•Permit#. :1---- ---------_____ °___._"_ - _- ----"` ] -----------------k- Septic Tank(Specify Requirements)-------------- •=_-'-==---__-.__-- ------------=---:----- - -- -------- ----== -------------- --------------------_----- g Disposal,Field (Specify Requirements)--...... = --------------- ------------- ----------------- ------ ---- ------- ----.- . , A --------------- i . 4' ' !. (Draw exis#ing an�equlred addition on reverse side) I hereby certify that I have prepared this application ianXt�avthe work will be done-�in•-'accordance with San Joaquin' County Ordinances, State Laws, and Rules�and Regulations Lauf the San Joaquin Local Health District, Home owner or licensed agents signature certifies the following: E "I certify that in th'e performance of the work for•which this permit is issued, I shall not employ any person in such manner as to become subject,to man's .Compensdtion laws of California." Signed t .,-., - ' .. Owner -------------------- 'T BY - - - ---- ------ - it (If other ihari:owner) '. FOR-DEPARTMENT USE ONLY APPLICATION ACCEPITED' BY-:-------- C\�--- ---------------- ----- -- ---DATE -----5_ s� - ----- ----- -- DIVISION OF LANMN' EMBER=----------------- -- .DATE-------------------- ------------ ---- -- . ADDITIONAL COMMENTS------------------ - -------------------- ------- -----E---"�'---------- -------�-------------------------- - �. �l --��p- ----------------------------------- -- - - - ---------- --- ----------- Final-Inspection b = —..� _ . _: c p Y=.�__ "-- ----- ------------------- - - ---- --- EH 13 24 SAN JOAQUIN LOCAL HEALTH DISTRICT Fas z,e» Rev. ��6 3M 1 �1