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J t FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No. .�Z' (complete in Triplicate) It -...... ......... - ................... .... P Date Issued 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: i, _----._.CENSUS TRACT cam.--�T...._... JOB ADDRESS/LOCATION ........-.�-.-..-.-- --,- .--------------- - -10 r P Owner's Name FY. 1Y-Z_lA... -t✓�Y.4.s -I cisj-_----....._..Phone ..................... - rAddress .------------ �--- --- - ---- ------- CitYt-'.� ...... --...---._...... ----._............... Contractor's Name .-./r'--- - -.4.L►`f'---{.-_SDLY-........___ti.:,.._. .License �86, Phone _.✓.r.-�'3. yaf Installation will serve: Residence ❑Apartment House Co"'g-ercial❑Trailer Court Motel ❑Other ...G Y/2?.e ....... S T"A7"i'a N Number of living units:............ Number of bedrooms ........._.Garbage Grindle�r`��--.----- Lot Size .___.___.._...--------..----- ------- �_ --- Private OK Water Supply: Public System and'name ...-.---------------------- ---- --- i ICla pea} Sand Loam ❑ Clay Loam❑ � . .._ Character of soil to a depth of 3 feet: Sand❑ Silt❑, b , y ❑ ❑ - Y_ Hardpan ❑ Adobe ❑i Fill Material -------- --- If yes, type ....----------- ------------ I (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) v NEW INSTALLATION: (No septic tan or seepage pit permitted if public sewer is available within 200 feet,) 7* PACKAGE TREATMENT [ ] -SEPTICYANKip ✓1/ c� -�' X ------ - Liquid Depth ......Y.......__.._.-. C P Size--'----- x o Capacity �.: �-O...,_. Type .6--Y�'CAS,/Material_. �. -�'.--- No. Compartments .--- - � ' T Pro Line --------- Distance To n4drest: Well - [.....---!.-foundation .._�............... p. p. / [ . s Total Len O.��....'....... ...... T LEACHING LINE [ l No. of Lines _.,..../............... Length of�a(�cH�line.._..__��-- - -- 9��r •D' Box ...../....- Type Filter Material liz_jluJcr�Depth Filter Material .....a ..........................••--- r / e Property Line. ........................ Distance to nearest: Well .��. ,,,may --------- P � r� 11-1-1- SEEPAGE . Rock Filled Yes ❑ No I❑ 1 SEEPAGE PIT ( ] Depth ;�......-----.------ Diameter ------ --------- Number _..............----------- ; l Water ;Table Depth Rock Size Pro Line ..............------ Distance to nearest: Well ...................._.-----.-------••-Foundation P• / I Y REPAIR/ADDITION(Prev. Sanitation Permit# ..----•-----------......-............�--- Date ------------------------------ —>✓tiar}Fi. .AtQ sl22vo� � N { ---- --__-------................ Septic Tank (Specify Requirements) -------- -------------------------- CS-1 7 �-t i-1-3f1� y{ziVo Disposal Field (Specify Requirements) ----------- -----•------------i------------------------------------------.............................. 1 - ----------------- ------------------------------------------------------(.........--.......------'-------...----...........--------'- (Draw existing and required addition on reverse side) I hereby certify that I have prepared this application and that�;he verk will be done in accordance with San Joaquin County Ordinances, State Laws, and Rules and Regulations of the SonJoaquin Local Health District. Home owner or licen- sed agents signature certifies the following: _ t ""I"I certify that in theerformonce of the work for which this permit is, I shall net employ any Person in such manner ,p as to become sublect to Workman's Compensation laws of Calif mia." Owner Signed ! = w.77 K -------- SOS------------------- 1 .... --- - Title ... By ---- --- -- - - - (If of er nerl FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY yi..... A :.L7 _.._.. - --------------J - -------.... --------- DATE --- BUILDING _ -- - - --------- BUILDING PERMIT ISSUED ... ` _............................................. ......'-----.....------..----- DATE -------- -------------- - ADDITIONAL COMMENTS - - -- ---- --------------------------------------------------....._-------- . ..__....- - .........................- . .... ..m_,_.... ...................... . . ..........:-- ------------------------------------I ............. .......................... . 7. --------- --------------- --- ---- -- ---- --------- --- .. . .Date ----- Final Inspects _.......... - SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1=68 Rev. 5M