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FOR OFFICE USE: FOR OFFICE USE: 'LPPLICATION FOR SANITATION PERMIT (Complete in Triplicate) Permit No-----7 Date Issued_.�o-'�2."-�� - -------------------------------- -----------------_-- This Permit Expires 1 Year From Date Issued ��/ [ ,(��, Application is hereby made to the San Joaquin Local Health District for a permit to construct an�tal t( Ke wol FerEin ed-scribe'? This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations7d JOB ADDRESS/LOCATION_ -Z3.44 3.------ -x.-_.�QN- .7R_ .�- --------- ---------CENSUS TRACT66-------- GQ� Owner's Name_ -Oht t?-LG - ----_---_-Phone_- f Address - -- City. - - - -- - -----Zip — - -- -- ContractorsjNVam ___ /ICk-rt�� Rd//Q� License #.-------------------------Phone--------------------------------- •Q !YJ Installation will serve: Residence�[. :AprNent louse 0 Commercial F] Trailer Court E]Motel Ot4r---------.------------------------- -------- Number of living units: ----------------Number of bediooms....�__'9Garboge Grinder...X-----Lot Size-------------------------------------------._.__---__-_ Water Supply: Public System ' nd name------ - '----- ------------------------- --------------- ----------------------------------------- - ---------------Private ( Character of soil to a depth of 3 feet: Sand ❑ Silt❑ Clay E] Peat❑ Sandy Loam.X Clay Loam ❑ Hardpan ElAdobe;❑ Fill Ma'terial-_.- -------If yes, type- -----------------.._-.---_- (Plot plan, showing size of lot, location of system in relation to wells, buildings,.etc. must be placed on reverse side.) %0 NEW INSTALLATION: (No 'septic tank or seepage pit permitted if public sewer is available within 200 feet,) l„I PACKAGE TREATMENT [ ] SEPTIC TANK /e(lj~ r r rr 4' Size--------- ------X----I----�---------------Liquid Depth.-&.--'�-----------1 Capacity-1Y200- A1_Type.C4Ltltc✓7._MateriaL_-______________________No. Compartments____-----------------_--- Distance , � d i � ------'�------'----W Distance to nearest: Well ... .aZ.00 -__Foundation--A0-. .____.-.. -Prop. Line 40 LEACHING LINE [ ] No. Qf Lines. _.2 - Length of-each line _70 Total Length ___.1@PO h 9 -- r r D x_.p ...TType Filter Material,-- -r$cI�_.Depth Filter Material.__�--------------____.-_--_-__- r r O /--------- Distance ...--- .. -. Distdnceto nearest: WeIL-4100--------------_Foundatigon.--- V____--.----.---Property Line-4-W-___.--_....____ SEEPAGE PIT [ ] Depth./off_--__Diameter./O--------------Number_---dc -.---_____-.-_--__ Rock Filled Yes]� No❑ Water Table Depth-- ------------------_----- ------------__---------Rock Size----- e� - ----- — - - - ' i Distance to nearest: Well_---%0W-__-_______-_-..___--_-___.Foundation-___-7/.0--------------Prop. Line----- 7..0._---------- REPAIR/ADDITION (Prev. Sanitation Permit#_-_--.__....................___- _.-_--___-__.:Date-_-__--__--_ -____---__________-_) SepticTank (Specify Requirements)-------------- ----------------- ---------------------- ---------------- ------------ ----------------- --------- -- - ---------------- Disposal Field (Specify Requirements)----- --------------------------------- _- - -------------------------------- --------------------------------------------------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: "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 subject to Workman's Compensation laws of California." Signed.._....---- .....---.._....................... ........ ....._.....— Owner By.........--------`---------------.----------------------------------------------------------- Title.__ __-..-..---------------- - ------------ - -------------------- (If other than owner) FOR DEPARTMENT USE ONLY - APPLICATION ACCEPTED BY +dill Q ------ -- ------- - -----------------------DATE.------ �47 _ -`- �i -- - - DIVISIONOF LAND NUMBER.-------------------- --------------------------- -- ---------- - ------------------ -- _-------- DATE. - _.--------- -------- -------------------- ADDITIONAL COMMENTS.---------- ----------------------------------- --- ---------------------- --- --------------------------------------.--------------------------------------------------- --------------------------------------------- ----- --- -----------.._._..------------- -- --------------- --------------------------------- - - -- ------ ------------- Final Inspection by:.,- �j�. - - - - - Date--- EH 13 24 SAN JOAQ LOCAL HEALTH DISTRICT F si REV. )/]6 3M