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FOR OFFICE USE: ._ // / �A PLICATION FOR SANITATION PERtfiT -- �`7" a 7 --- 7 lZ ;'U Permit No. (Complete in Triplicate) (�- ! Date Issued __.----_____________-____--_--___--------- /„3his Permit Expires 1 Year From Date Issued Application is hereby made the an oauin Local Health District for a permit to construct and install the work herein described. This application is md5w� ce with County Ordinance No. 549 and existing Rules and Regulations: * PA%L E Sar O P_ 5 D" Ass G9CEN 145 E-- Ge GO JO ADDRESS/LOCATION - �1--_ __- __.-QN-96) -ERTS---RJ---rAKE--I---t- ----v ----CEN US Owner's Name .- SLE_-_ �------- -----E774R,5'O /_--- -----------------------------------------------Phoneg-77-r-S.57/------- r Address - C[? !- D - PLA -. - 1 ` y5 A ` - - Contractor's Nam -_Q—R_ SiA-----�--_-_SOA _5--------------License # 1157194777_1----- Phone4&&_ 07.__ Installation will serve: Residence ❑Apartment House❑ Commercial ❑Traiille`r,,,Court ;❑ Motel F]Other -MDQ-I-LG---�.A1LF� U�E Number of living units:--- ------- Number of bedrooms _Z -----Garbage Grinder ---_---- Lot Size :.-q...ACPUE. _____________ '- Water Supply: Public System and name ------------------------------------ .----------------------------------------------Private Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat❑ Sandy Loam K Clay Loam ❑ _ Hardpan ❑ 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.) L, NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ ] SEPTICTANK'DQ Sizer.X_ - - ----------------------- Liquid Depthlsfz___--___..____- Capacity/9Q0-------.-- Type-eAt6&A. Materialjt __ No. Compartments _ __.. ------ r t Distance to nearest: Well __Z;3QI9.. _r_-.-__-----_-_Foundation _ Q _ _ _-- Prop. Line _�-��----____-- x� �Q---------------- Total Length _-`-9-Q------------- LEACHING LINE [ ] No. of Lines -----.-_--_- Lengt of each line---_-_ g D' Box --_ ------ Type Filter Material k1'Z --Depth Filter Material __/ ___________________________________ Distance to near t: II —S-00........ Foundations_________________ Property Line ----_--__._____ SEEPAGE PIT [ J Depth e No �] • v Water Table Depth -----�----- -------------- -------Rock Size --x- -------- --- \ Distance to nearest: Well - ----------------------___Foundation -------------------- Prop. Line ----------____-_._--__ REPAIR/ADDITION(Prev. Sanitation Permit# -------------_-____----_____--.--_----- Date __--________ ___ - ) Septic Tank (Specify Requirements) --- --- -- `'��✓ ---- - ------ ---- -- ------------- DisposalField (Specify Requirements) ----- -------------- ----- --•--- ------ --------- ----------------------------------------------------------------------- -------------------------- --------- -------------- ------------------------------------------------------------------------------------------------------------------ -------------------------- (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 licen- sed agents signature certifies the following: "I certify th ' the performance of the work for-which this permit is issued, 1 shall not employ any person in such manner as to beco e s bject to�Wor an's ompenaat' n laws of California." Signe -------- -- - ---- - - - �;;:---- -�- - --- -- - - ------ ------ --------- -- Owner .� BY - - Title -- J-x------------ - - --------------------- (I other t an owner FOR DEPARTMT USE ONLY APPLICATION ACCEPTED BY ----- -- ---- - - - -------- ------ DATE -------Yw/ /------------ BUILDING PERMIT ISSUED - - DATE ---------------------- ----------------------------------------- ADDITIONALCOMMENTS ------- ---------------------•------•---•--------------------------------------------------------------------------------------------- --------------------- ------------_--=` -----------------------------'---------- - ---- ----------- -- ----------------- ------------------------------------- --- --------------- -------- `_ --------------- - -----------Z------------ -`- -.-------------------- -------------------•------------- - - -------- � -------- -------- -------------- Final Inspection by: _',.� -------------------- -------------Date ---- l`1—.� ' r ;�` SAN JOAQUIN LOCAL HEALTH DISTRICT