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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT �� t {Complete in Triplicate} Permit No. .. ....... ..... ... ......................................... .. This Permit Expires 3 Year From Date Issued Date Issued 10.. �:.. j Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein i described. This application is made,in compliance with County Ordinance No. 549 and existing Rules and Regulations: Jl JOB ADDRESS/LOCATI N ,..'_2 ----- a=J�.�f�•�. 17�LLQ U1.�.......CENSUS TRACT .................. E Owners Name ........(.1.. !7.1 o --.----B.).B.Nc�. ... ........... ........Phone .................................... Address .......-. L-� `-..-...5 . CD�--.ti.R f l7....j? City .TFI �-�........ .................. i Contractor's Name ----------------------- ---------------------------------------License # �.'��''"1""�i}-�;..��hC`�"uT�i"` T`.�.:�:.": �/� --------- Installation will serve: Residence Apartment House Commercial 6TAEler_Court �] -"—N W Motel ❑Other -.. .. . ..-. ....,x:.. t t• _ t. r. Number of living units:.---. -..-.- Number of bedrooms ..-_ -......Garbage Grinder,!- Lot Size i Water Supply: Public System and name : ,116-41 _ t, Private ...-------------•-•-------------------- 0 Character of soil to a depth of'3 feet: t Sand Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ •- aINA � Hardpan ❑ Adobe❑ Fill Material --------- If yes,type ---.-- t $ ----........ .ten (Plot plan, sho..w,i.ng_size_of Lot, location of system in relation to wells, buildings, etc, must be placed on reverse side.) Q NEW INSTALLATION: (No septic tank or seepo9p_ i -errmittet if public sewer is available within 200 feet,) _ PACKAGE TREATMENT [ ] SEPTIC,TANK ig�. _M._�a terra I C. Liquid Depth -------------------------- Compartments . fes..__. � . ..--- Compartments ...-? . ........ capacity 4.00f_ Ri....:.Ype istance to nearest: Well lV _... ., ._Foundtion ._-�r .. __. Prop. Line ...................... k LEACHING LINE[ No.; of Lines ------ ...... Length of each line--.----� �....p _. Total Length ....3 ............... 4 r—A C_.H I nT 13 F_p D. gox - yp M� r t .FI: , r, T e Filter Material ..-....... ..Depth Filter Material . .-..�i�....__ T._..: Di,stan a to nearest Well Foundation ...-.- `r`--_ fptopertly Line SEEPAGE PIT [ Depth ---------------- --- Diameter --- Number ------------ --------- ---.- _ - -- �-.. 'Rock Filled Yes ❑ No �J '2 I i `''i Water Table Depth _.....Rock Size ' Distance to nearest: Well ....... i I .art ........................................Foundation _-....:.... ........ Prop. Line REPAIR/ IN(Plv.;Sonitation Permit# ' ................ ...................... DateJ�...........,.... Septic Tank S {cRequirements) ... . . :�.._ .----�;.........) -r -----------•- Disposal Field Spect Requirements) ........g� -----•- C ................................ LJ i y •--•-•---- ...... ----------------------------------- •-. yy ----------- . (Deow existing„a(T&.r."equiii'aa8ition on,reverse`side) I hereby certify that I have prepared this application and that the work will?be, done yin accordance with San Joaquin County Ordinances, State Laws, and Rules and Regul6ii' nsof the San-Joaquin Local,;Health4Dislr1[ct. Home owner or licen- sed agents signature cern es the followin g:. °'I certify at i the Performa of the work for which this permit is Issued, I shall not employ 6ny person in such manner as to be a blect to Work Compensa on laws of California." t Signed ..--.... .. . Owner BY ....................... Jit �C�Title ..-. (if other than owner)----------------- I FOR DEPARTMENT USE ONLY r APP,LIGATION..ACCERTE D.:.BY........ ............................. .........• --•--- ..........................DATE BUILDING PERMIT ISSUED ^° -----s• ...... ::.:____... �::......._: DATE ADDITIONAL COMMENfiS`1-4: :: . r`9 el 0 ....---••- .--------•-•-•---------------------••-----_..... ......... ........ --...... Final inspection - ..Date ... !� aAN JOAQUIN LOCAL HEALTH DISTRICT I E. H.1.3 24 1-'68 Rev. 5M. 4 7177 1 .K