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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No. .. (Complete In Triplicate', This Permit Expires 1 Year From Dote Issued Dote Issued .......:............ Aoplicotion is heraby made to the San Joaquin Local Health District for :i permit to construct and install the work heroin described. This application Is mode in compliance with County Ordinance DNo. 549 ona existing Rules and Regulations: JOB ADDRESS/LOCATI 4 - ..� �i11wGr>I�.c .t>�...1'�+. . CENSUS TRACT ............ ...... ...... Owner's Name _.. .. VP�sif�s.Q . . �. ��Ric!^�n-rt.. ..`.....n...�....... ..................................Phone ��..9�1 .._.... AddressCJIA:GGa .i} '-, M City .. Contractor's Name ........ � ............................licnnso +# ..Z Sy.'3. .jt. Phone CKIC..'Y.L0..2.. . InsssllMlrn will se•ov P•1 ^AportrnWo Hewee0 CAN"Ptomw OTroshrc4wt O Metol ❑Other r Numbur of living units,.. I Number of bedrooms ...Y.Garbage Grinder ............ lot Size ........yo....4- i Water Supply: Public System and name . ..........................................................................................................Private Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat❑ Sandy loom ❑ Clay Loom ❑ Hardpan❑ Adobe ❑ Fill Material ............ If yes,type............................ (Plot plan, showing size of lot, location of system in :elation to wells, buildings, etc must be placed on reverse slide.) NEW INSTALLATIONt (No septic tank or seepage pit permitted If public sewer Is available within 200 feet,) PACKAGE TREATMENT ( ) SEPTIC TANKT }Slze...�'f.1C. ..Q.-_•.•-••-••••••••• • Liquid Depth .5 .......»»... Capacity 1 . ...... Type -I�P�-ll........ MclWIal.C.�:. Z4.<11-t... No. Compartments ..Z Distance to nearest: Well ........ .....................Foundation .....11a........._. Prop.line.�»�'.......� 1 LEACHING LINE No. of Lines . ?/............. length of each line./fo."0....0. Total Length 'D' Box .....! Type Filter Material 4Mk.......Depth Filter Motorial ...1-k.................»........ J� Distance to nearest: Well ....Sd............. Foundation ..../..Q.rt......... Property Line• •»•»•».»r SEEPAGE PIT O Depth Diameter ................ Number ............................ Rock Filled Yes ❑ No Qrn WaterTable Depth ................................................Rock Size ..................._........... Distance to nearest: Well ........................................Foundation .................... Prop. Line ................. e ! i PEPAIR/ADDITION(Prov. Sanitation Permit# ............................................ Date ................................) 6 SepticTank (Specify Requirements) ............................................................................»...._......................_............._.............._ y Disposol Field (Specify Requirements) ••-•--------------••••.. 6 ............................................................. .......... .............. ....... ...........................................................................,...................... . . . Vol............. .................................... ....................... .. ............................._.......................................... ............................................. (Draw existing and required addition on reverse side) I hereby certify that I have prepared this application and that the werk will be done in semdenee with Sen Jeegsttrs ) County Ordinances, State laws, and Rules and Regulations of the San Joaquin Load Health DkMd.Merge eWFW of 11cm sod agents signature cortifies the following: "I certify that in the performance of the work for which this permit Is Issued, 1 shell net employ VV person In such WAUV or as to become subject to Workman's Compensation laws of California." Signed ...........�if ............. ......... .. Owner ..................................... By . .:....... ...................................... Title ......... !................................................... ther n owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ...� �/ �}-,,t,i%G• .......................................................... DATE...1 � ........». BUILDINGPERMIT ISSUED .................................. .....................................................................DATE........................................... ADDITIONALCOMMENTS ............................. ................................................................................................................................ ..................................................................................................................................................................................................._.... :.......::..::.....:......................:A......... ...................... . ................................................. ......DOte.. i ... ."..� .�. Final Inspection by. .............:1!./.::......r..r.a..l..� ....................................................... SAN JOAQUIN LOCAL HEALTH DISTRICT E. H.13 24 1--68 Rev. 5M 7/72 3 K