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FOR OFFICE VSE: .' APP1,fCAT10N FOR SANITATION PERMIT � Permit No. * - - (Complete in Triplicate) ---'--"-•"--------------- ----------------------------- 1 y --------------- This Permit Expires 1 Year From Date Issued 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 applicatiop is made in compliance,.with County Ordinance No. 549 and existing Rules and Regulations: tet'. t e JOB ADDRESS/LOCA R- _ ---8. _.--5T[_F6.V-CENSUS TRACT --S-.-yC---------- Owner's Name ------L.. ....R0y-'-'--._4JEEMAiV-`---------------------------------y�--------------------Phone ------------------------------------ Address ------ _ .Q ?,'/ / 1�}- ------------------- City ----- ES 0--------------------------------•------ Contractor's Name ____-E�lel(!1J( `----------------------------i------------------------------.License # ------------------------ Phone ------------------------------ Installation will serve: Residence ❑ Apartment House❑ Commercial ❑Trailer Court ;❑ Motel ❑ Other:,_`�C.-_ �- 1'V1---------- Number of living units:-_ ^ Number of bedrooms ---- ----Garbage Grinder_- _--_ Lot Size _-/-t-c---E � - --------------------- Water Supply: Public System and'nome --------------------- ---------------------------------------------------------------- -----------------------Private [tom^ Character of soil to a depth of 3 feet: -Sand'❑ Silt fl Clay ❑ Peat❑ Sandy Loam -❑ Clay Loam Er— Hardpan Fr Adobe ❑ Fill Material /1/0-- If yes, type ________________________ __ (Protowin Ian, showing # P g'size of lot, location of system .1n gelation to wells, buildings, etc. must be placed on reverse side.) V",Q NEW INSTALLATION: (No-'septic tank or seepa pit permitted if public sewer is available within 200 feet,) -� PACKAGE TREATMENT.'[] SEPTJC-TANK' Size.__ ___X �__X------�-_._____._ Liquid Depth ______ ___ Capacity AP -�____ Type -R: � CASTMaterial�NCF3cTE�.o. Compartments _ _�. �—'.. s. pp r istance,to nearest: Well ----------- ----------------Foundation __ lG�.___'�____ Prop. Line __,,�-."''�:...__ i � LEACHING NE No. of Lines .__->�_--------- Length of-each line--- --------------- Total Length ,_�S�Q................ 'D' Box V6-- Type Filter Material• Q_C�__Depth-Filter Material ______� _______________ __________ istance to nearest: W011'4_5 ------------ Foundation...-.<�a--------------- Property Line _5-_______________ SEEPAGE PIT [ Depth --- Diameter Diameter'T-_X _r-_ Number --------2-r_------ Rock Filled Yes P'�No i❑ Water Table' Depth ------A1Z_-----------------------------------Rock Size-.Z'------��/ r Distance to nearest: Well ----1-400--------------------------Foundation --- ---- Prop. Line ...6.._.--_-------- REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date ----------------------------------) Septic Tank (Specify Requirements) --------------------------------------------------------------------------------------------------- ------------------------- ---------- Disposal GField (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 sig ature certifies t following: "I certify th m the perfor anc of the work for which this permit is issued, I shall not employ any person in such manner as to beco subiect to W kr Compensation laws of California." Signe --- 9 �-- ---- -----------e----'------- Owner By ---- - --- --.-R------ -------------------------------------------------------�R- Q = Title -------------------------------------------- --------------------------- (If other than owner) �-�-�. FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--------# ---'R!l7-f9M--------------------------------------------------------------------. DATE ---- BUILDINGPERMIT ISSUED ---- -------------------------------------------------------------------------------------- -------DATE _.----------------------------------------- ADDITIONALCOMMENTS ---------------• --------------------------------------------------------------------------------------------------------------------------------------------- -----------------------'--- --------- - ------ -- ----------------------- ------ -- - -------------------------------------------------------------------------------------- --------------------------------------- --------- ------------'-------------- -- -- ------ - - -------�- ------- -------------------------------------------------------------------------------- ri_ - - --------- --- ---- - -_,----=J---- - Final Inspection`b - ---- - -------.Date [ '- ` - SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M. p