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FOR OFFICE USE: ° '`v \. APPLICATION"FOR SANITATION PERMIT �7 _ �= ----------------- -------- o Permit No. --:7,7`"93-- 4 � [Complete in Triislicate) ---- �--- -- - 'F I Date Issued ------------------ 1 LIP : This Permit Expires 1 Year From Date Issued --------- --------------- ----------------- Application is hereby made tc 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 ADDRESSAOCATION ./- -------` (el _ - -- Ae-------------------.---------CENSUS TRACT' `-------------------------- - Phoe- ! ------------------------- ----Owner's Name -L 9 . Address ------------------ ! l� City --------------- -------- ----------------- -•-- - - -�- 7777 7777----=----- -- --- 7777 - -- - 7777 - --- f �' License #+�_21, 3- --- Phone'__`-"$- .--- ---------- Installation -`� r Contractor's Name ---_ -------- 11 t-------- -=----- Installation will serve:._. .- ._ Residence Fpartment House❑ Commercial ❑Trailer Court ',0 i Motel ❑Other --------------------------------------- ---- s Number of living units Number Number of edrooms --__Garbage Grinder/ `IP�-- Lot Size . _-- ---------------•-• Water Supply: Public System and name ___ 11 - -----------------'-----------------------------------Private ❑ Character of soil to a depth of 3 feet. Sand ff Silt❑ Clay Peat❑ Sandy Loam.e❑ Clay Loam.❑ i ► --4 Hardpan ❑— Adobe_ r.F.ilLMater.i.al_ if yes,type ---------------------------- P f (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,) : PACKAGE TREATMENT I I SEPTIC TANK',X< Size-_-�n_� -------------- 7777-- Liquid Depth _ Z 7777.._______ W Capacity �@ ---:-- Type �'Materiai__-- -- - o. ;Compartments ---2- r 1 pis ce to nearest: Well -------__7777---7777---------------Foundation ._./--� ! Prop. Line�/-------------- f --- 1 ° , LEACHING LINE [ No. of Lines la i____-- _- Length of ach line---- _-- � Total Length --- -777.7:--...__ t tl 'D' Box -- __ Type Filter Material _ -- ----Depth Filter Material ----- ___� ------------------------ Distance --_- __-__••-7••Distance to nearest: WeIIj•-_`_- ' ___� Foundation . /0 .............. Property Line -a __- _--...... -ew -- -aw SEEPAGE PIT [Depth _ _.---__ D�ame�try _--rte"7777_ Number ... /-,- _-_-.L-J-.___ Rock Filled Yes Na i[ Water Table Depth -----------1V-r-------------------------Rock Size ---ZAZ4-2--1------- Distance to nearest: Well ------Af-A-------------------....Foundation ----�_�__�----- Prop. Line _......:-- REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date -------------------------=_--------) 3 Septic Tank (Specify Requirements) } t , Disposal Field (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 liven- , sed agents signdfuee certifies the following: "" "I certify that-in'the-performance of the work for which this permit is issued, 1 shall not employ any person in such manner as to become subject to Workman's Compensation laws of Coliforhia:; f t Signed - == ------------------------------- --------- =Owner By ------------------ ----------- =" L�4� -l----- :Title ._e. -- f ,(If other n owner) ..r.__+. _ OR ARTMENT USE ONLY APPLICATION ACCEPTED BY ----------------------=---------- I DATE .----------------------------- -- - ----- ------ -- -= -- - j --------------7777-- BUILDING PERMIT ISSUED .------ -- - ----- 1---- DATE ADDITIONALCOMMENTS -- -- --------------------------- ----------------------------------- -I------------------------------ ------ --------7777-- --- ---------------7777-- 77 77-7777-:--- --- --------------------------------'---------------- ------;--------- I-------------------- -------------------------- ---------------------=--------------------- = i .. r. -. �.. _,_.. " ----- -------------•---- -------------------------7777-------- 7777-- - -- - 7777- - - - --- -- - 7 -r -- - Final Inspection bY: -rsr ,� R;�.---V11 --------------Date --- f7 ? �-. _- - -- - 7777- �--= _ jj-7----- =" 7777- 7777-- --7777-- -- SAN JOAQUIN 'LOCAL HEALTH DISTRICT IY E. H. 9 1 '68 Rev. 5M "A.