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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No. 7- __1 �7-y ,/ --- ------ ,�--- --------- ------ ---- J A " - I` {Complete in Triplicate) 1_0 ---------------------------------- Date Issue ---------•• 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: IM_ � _c�Cc� r r �L _ ' CENSUS_TRACls .S t JOB AbDRESS/LOCA N ------Phone ---------------------------•-------- Owner's Name PIO A�t�--- --d' �------ �8 ------------------------- ---- Address ------- -----,,--L fe C ^+� City = i '� License # Phone Contractor's Name --- --- - -- -Installation will serve: idence par, House❑ Commercial:E Trailer Court '❑ 1 Motel ❑ Other -------------------------------------------- _ ' j� 4 1l tVe.-_ Lot Size ----f� -�f,(6 ------- . Number of living units:_--:°�-.-.;- Number of bedrao s -�--.---Garbage Grinder __- - - 6N ------_-Private ❑ Water Supply: Public System and name ------ lexy-J ------------- ------------------- ---------- ------------- Character of soil to a depth of 3 feet: Sand' Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ F I'I Fill Material -------- if es,.type I� Hardpan ❑ Adobe'❑ Y (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) 6R } NEW INSTALLATION: (No septic tank or seep❑ pit permitted if public sewer is available within 200 feet,) / v PACKAGE TREATMENT r]r SEPTIC TANK [ Size-------------------------------- Liquid Depth --------_� ---.----- `y (°'? q ` / -------------------- V ; Cp -C7 Type Material No. Compartments ait stance to nearest: Well Foundation --�C -------------- Prop. Line -----' ------,------ LEACHING LINE �[�o, of.Lines __.- ----------- -- Length of each lined -V74k2----- Total Length :-- � -------------- Nk 'p' Box -- _ Type Filter Materiak� - Depth Filler Material ---------1 ------------•------ IL bstance t-o nearest: Wel! ---_-----._------------ Foundation / ' Property Line ------------ - --------- SEEPAGE PIT [ ] Depth --------------------- Diameter ------------ Number ------ --------------------- Rock Filled Yes ❑ No 0 '-4--Water•-Tble Depth ------------------ ---------------------------Rock Size ane Distance'to-nearest:.!Nell--__---------------- — _ ----Found❑#ion -------------------- Prop. Li i REPAIR/ADDITION(Preva"Sanitation Permit# -------------------------------------------- Date ----------------------------------1 II --r_t Septic Tank (Specify Requirements) ----------------------------------------------------------- --------------------- ---------------------- Disposal ------------------- .._-.. r Disposal Field (Specify'Requirements) ---------------------------------------------------- ------------------------------------------------------------------------------- I! ==---------------------- ------ ----- ----- ------ --- ------ --------------------------------------------------------------------------------- ? - ��_� - ------------------------------------- ------ ------------------------------------------------------- ------------------------------ _ ..r. . _ �- (Draw existing and required addition on reverse side) �( I hereby certify that I h �ve prepared this application and that the work !will be done in accordance with San Joaquin County Ordinance's, State Laws, 'and Rules--and Regulations of the San-Joaquin Local Health District. Home owner or licen- sed agents signature certifies the following: f. "I certify that in the performance of the work for which this permit is issued, I shall not employ any person in�ch,0 nner as to becomes j�Vvdin' •Coinpensati.on laws of California." y /a Signed ------------------------------ Owner f° Y/ r ?-. ----------- - ------- By _ _ ------------ -- Tithe ---- -------- ---- --------- - (If other than owner) 1 FOR DEPARTMENT USE ONLY t I� _ J� C APPLICATION ACCEPTED, BY ---------- DATE -.lam- - ADlLDING D 7 ONAL COMMENT'S NTS �- mac- `=_: '-' ='----_--_- - ----- =-- - - --- ------ ___::- ---------------- ------- -_----------------------:_=_=___----________--------- ---�---- ----_-_____:___:___ -- --.� Y I ' Final Inspection b � -__-----.Date -.jc.7--�---- ---"----- ---------•------- -------SAN JOAQUIN LOCAL HEALTH DISTRICT . i jyk :-E. H. 9 1-'h8 Rev. 5,