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FOR OFFICE= USE: � ! APPLICATION FOR SANITATION PERMIT - --------------- D � (Complete in Triplicate) Permit o. __ __ _________ ---------- ------------------------ 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: JOB ADDRESS/LOCATI y N ---_f : ---------�-------- ---- Z�POr�I ----------- --` CENSUS TRACT �- (r 1 ' Owner's Name --------- --U-t4---�---E-V--�-�Q_L-��-�1�-- -----------------------------------------------Phone --�� Address ---------------ij7 ------��.._------ City ---------------------------------------------------------------.._..-------- Contractor's Name -------4 WAl -R-------------------------------------------------------License # ------- ----------------- Phone --------------- - Installation will serve: Residence ❑ Apartment House❑ Commercial OTrailer Gemi Motel ❑Other '-------------------------------------------AA,, Number of living units:__________ Number of bedrooms -_�-Garbage Grinder _1V D_--_ Lot Size ___ iUR _11)_CZr�----__ _ Water Supply: Public System and name ---------- --------Private Character of soil to a de th of 3 feet: ' Sand' Silty Cl Peat — and Loam Clay-Lod—M-0 ;. p ❑ Y ❑ ❑ Y ❑ Y' . .w__ Hardpan ❑ Adobe❑ Fill Material __ If yes, type __________________-_______ i (Plot plan, showing size of lot, I cation of systemf in relation to wells, buildings, etc. must be placed on reverse side.) JNPW INSTALLATION: (No septic tank or seeps pit pefmitted if public sewer is available within 200 feet,] �r J ,',PACKAGE TREATMENT [ I SEPTIC TANK 10 X- �^- t� P [ Size- ----- Liquid Depth ._./ y `F Capacity ZOO------ Type. g- fiMaterial--(f �i '® No. Compartments ------ ---•6 C__,I>s tante to nearest: Well :=__ ----- ;`____________Foundation __. --------- Prop. Line ----- 5....._______ I LEACHING LINE [ No.�of Lines =_--_r1�:_____� Length of each line______-----�'____ Total Length ........-_ € yy I 'D' Box - Type Filter Material Depth Filter Material ----------�� __ __________________ N Distance to nearest: Well _ _____________________ Foundation -----------I---_---- Property Line it SEEPAGE PIT [ ] Depth Wit--------------- Diameter ---------------- Number -------;-- ------------------ Rock Filled, Yes ❑ Nd -- .p Water Table Depth ':- —g Rock_Size ` f f. I t __ stance to nearest: Well _____________________________________Foundation -------------------- Prop. Line ....................-_ Ao I } � REPAIR./ADDITION(Prev. Sanitation Permit# ________________________._____-- __---- Date ----------i_______-______________ Septic Tank (Specify Requirements) -- ------ ----------------------------------° r"------------------------------------------------•-------------------------•---=------------- fDisposal Field (Specify Requirements) ---------------------------- - ------------------------------ ----- ------------------ -------- ------ ---------------------------------- i ---------- - ----------------------- ----.------_--.- _ ------------------- ---------------------------------- -1-------------------------------------------------(Draw existing-grid requred addition on reverse side) G 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 o� the'Scn`Joa�uin Local,Health District. Home owner or licen- sed agents signature certifies the following: "I certify t at in the performance 'of the work for which this permit is issued, I shall not employ any person in such manner as to be m subject to Workman's mpensation laws of California." �— Signed - -- ----------- ---------- -------------- -------- `-`----•------------------- Owner BY -------- --------------------------------- --------I---- -------------------------------------------- Title -------------------- ----------- (If other than owner) FOR .DEPARTMENT USE ONLY -7 i APPLICATION ACCEPTED BY -- l ` - ©------------------- ------------- -------------- DATE ------2-- ~ `y / t{ BUILID ING-PERMIT f . -ISSUED--- J —i -DAT=E EN .................... --------i- . -------Date f------- ADDITIONAL COMM = = ------------------- ---------------- -------------- ; _ --------------------------- ' ---- ----------- -:7 . ------------- _ = - --- -- --------------- --- --- -------- ----- --- - - -- -- ---- ----------------------------------------- ------------ s InSAN JOAQUIN LOCAL HEALTH DISTRICT / E. H. 9 1-'b8 Rev. 5M