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f FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT -------------------------- ----------------------- --- �� Permit No. ---� -- ----- (Complete in Triplicate) -------------------------------------- ----------------- / 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 application is made in compliance with County Ordinance No. 349 and existing Rules and Regulations: ,7 JOB ADDRESS/LOCATIONAil------`J�-� N----CENSUS TRACT --------------I----------- Owner's -- 5 ---- Owner's Name --- y F G-U��-�- �------ �—•_----------------------------�- ,- �0�.,� -- �--'-----•---------- Phone ---------------------I-------------- Address ------ 4 - -}1 3;R2------- - -r-- ---A161-& �-1/ 6f��t------------ -------------- --- City,--- -I-Pr-------------------------- ------------------------------ Contractor's Name --4 I; E.P----------------------- --------------------------------------License # ------------------------ Phone ------------------•----------- Installation will serve., Residence 0 Apartment House❑ Commercial ❑Trailer v.4> - Motel ❑ Other --------------------------------------=--•-- Number of living units:---- -. Number of bedrooms ---1--------Garbage Grinder,-#a--- Lot Size ---ACPmA��----------- Water Supply: Public System and name ----- �Y- -- Character Q __--f_�_1__Pa ----------------Private ❑ of soil to a depth of 3 feet: Sand' ilt Clay ❑ Peat Sandy Loom ❑ Clay Loam ❑ i 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.) NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet) gni PACKAGE TREATMENT { ] SEPTIC TANK:[ ] Size--------------------:---:-__---:;_---------- --- Liquid Depth ---_--__----------------- Capacity --- Type--------------------- Materiof----------------- --- o. Compartments ------ ------ �) .i . - - - .- r Distance to nearest: ell ------------------------------------Foundation ------- -------------- Prop. Line ---------------------- LEACHING LINE [ ] No. of Lines ------------- ---------- Length of each line-------------------------- Total Length ---.-------------_-._.---.-_ 'D' Box ------------ Type Filter Material --------------------Depth Filter M erial -------------...-_--_---------------_._-_--- Distance to nearest: Well -------------------- -- Foundation ------------------- ----- Property Line ------------------------ SEEPAGE PIT [ I Depth .'------------- Diameter ---------------- Nbmes:b _____---------------- -:--- Rock Filled Yes ❑ No ❑ Water Table Depth -- --------------------------------- --------Rock Size --------- ---------------------- Distance to nearest: ell --------------------------`=---------Foundation ___ - __ ---------- Prop. Line ---------------------- REPAIR/ADDITION(Prev. Sanitation Permit# - ---.------_-.-------------------------- Date -----_- __--- -------------- Septic Tank (Specify Requirements) ----------- --------------------------------------------------------------- Disposal Field (Specify Requirements) __ ---------5u __&--T— - ----------- �L- -----1'L1/----��----�1 4919c ------1?-�l/V�. ,fC ------------------ �------- -------60MC F-4 ------ I= Fi4��3----- ? 1L� � Z`f !D. gCu 11-I-N ---- ---------------- ----------------------- (Draw existing and required additi®n 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 ' the perfor n e of the work for which this permit is issued, I shall not employ any person in such manner as to beco s bject to Wo an's Compensation laws of California." Signed --- --- ------------ -------------------------------------------- Owner • BY --------------------------- ------- -------------------------- --------- ' ® Title -------------------- --------------------------------------------------- (If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ------ 7A-R-A9-------------------------- DATE ----�r� -- 71-------------- BUILDING PERMIT ISSUED ---------------------------------------------==---------=--= --=-=------=------=--------------------------DATE -------•-----•---•------•--------------- ADDITIONAL COMMENTS --------' - ------ -=--------------------------------------------------------------=-----------•--------------- e --------- _ :f --- -------- - ----- ---- -- -- -------- ---- - - -- -- -- -- -- -- --------------------------------------1dFinallpectlo ---- - - ------ --- - - --- ------ --- ----------- Dat ----------- ---- r SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'6$ Rev. 5M