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FOR OFFICE USE: = rpIPLICATION FOR SANITATION PERF � � Permit No: __7Y.7&2 -------------------------------- ------ �._ (Complete in Triplicate) •----------------- ------------------•---------- 7 -- Date Issued _---•--------------•� ------- ' This permit Expires 1 Year From Date issued j 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 Ordinan/ce No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION .----,/.D_0-__,.5�].---------Ix- 1.+(�1_ T� �C--------------------------------CENSUS TRACT ....----------•---.•---.-- Owner's Name ---Zv4srellf.....ZAI&k OTO-IA a--------------- ---------------- Phone --------------------------•- •------ Address ---- - 4d_- �. ! City -- � - Contractor's Nam .-- • License# 1 ,1 Phonec33c?rr�n�.... Installation will serve: Reside ce UJ- tpartment House❑ Commercial ❑Trailer Court ❑ Motel [].Other -------------------------------------- Number of living units:___1_------ Number of bedrooms __.___Garbage Grinder ------------- Lot Size .,e4p.. ,.............. Water Supply: Public System and name ----•----------------------------•---------•-----------------------•---------------------------•-------- ----Private❑ Character of soil to a depth of 3 feet: Sand 0 Silt❑ t Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam,1� Hardpan ❑ Adobe [Q Fill Material ____________ If yes,type -------------_------------ (PI'ot 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,) PACKAGE TREATMENT [. ] SEPTIC TANK[ ] Size_--I-C!r,__,S---------------------- Liquid Depth .......... ------ Capacity _124%4 .__ Type_-- Moterial,,gVL `= No. Compartments �-:.-'---- -4J ' r Distance to nearest: Well _aZ41 __________________----Foundation _ ca_----------- Prop. Line LEACHING LINE [ ] No. of .Lines _____,�------ Length of each line-__- '_______.-_--_ Total Length :_l _______________ 'D' Box _______ Type Filter Material .....Depth Filter Material j ________------_-------------,......... Distance to nearest: Well _ - ----_____ Foundation ......210--- ________ Property Line. __AS'.r............. + PAGE PIT [ ] Depth -------------- Diameter 47 ....... Number __.2 _ Rock Filled Yes [3'' No l❑ Water Table Depth .------ -------------------------------Rock Distance to nearest: Well -, ------------------------------Foundation -/ 5T.�__`_.---- Prop. Line �_.___..__ REPAIR/ADDITION(Prev. Sanitation Permit# --------- ----------------------------------- Date --------------_---_-------------) Septic Tank (Specify Requirements) ------------------------- 4u....-..-•--------------••-------__- -......-._-...--•-------••- Disposal Field {Specify Requirements) ------•--•-- ----------------------------------•---- ---------------------------------------------..-..---------•----------- „ = -----------------= - ... ---- 4 --------------------------------------------------------------- ---------------------- ------------------------------------- ----------------------------------------------- ;--•----• --- ------ (Draw existing an required addition on r verse side) !. 1 hereby certify that I ha a ppared this appiicatio and that the work ill be done-in accordance with,San Joaquin County Ordinances, State-Lav ed, Rules nd Regu ations of the. San Joaq in Local Health District. Home o;4ner or licen. sed agents signature certifies t�e folloyyLg "I certify that in tie performance of the work for wh ch this permit is issued)I shall not employ any person in such manner as to become subject to Workman's Compensation laws of California." Signed ----- Owner ! ---- ---- -- �t� _ ------- (I ----- Tit e BYf .�► - -------•----•---•----•----- --- (If other than ner) i ' i FOR .DEPART ENT US ONLY APPLICATION ACCEPTED BY_-- .--- -----_-- -•--•---• DATE __ �--ZG•y- ----••---•.••- ?' -------- ------ BUILDING )3ERNtl7 ISSUED -------------- --- - - ------------ DATE -- ----•; ADDITIONAL COMMENTS -------------------------------------------_-_-•-'-•--------------' ---_ . --- ---E�',�•¢• '----- ------ S:-------- ------------------- -------- -----------------• -- ------------------- --------------------------- ----- ------------------ -- ---- -- ----------- ---------=--- ------- - -- : -� -- DateLnal _ . ----- -- ------------------ .. N . JOAQUIN LOCALS HEALTH DISTRICT I E. H. 9 1-'b8 Rev..5M �