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V . FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT - ------------------------- ---------------------- ,0 Permit No. . (Complete in Triplicate) ------------------ ---------- ---------------------- — ` < This'.PermirfXpire4S-Yeb F m Date Issued Date Issued Application is hereby made tothe San JoagUirl Local Health District for a permit to construct and install the work herein described. This application ist made in compliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION - _�-- tet___________________f--_CENSI)S .TRACT,�R------------------------- -- _ _-__S_. � Owner's Name -- "� -- -'-- -- -- --- ----- -------- Owner's ----_t --Phoned Add .f-, � ,��, � 9 ' cess ! ''s �� -- ---------- Contractor's Name . ---c__-, _ --?_`-------------------- :-------License # _ 7;__.d_��2 Phone _ __ .7��,j Installation will serve. , Residence V3-A,partment House❑ Commercial : Trailer Court ;❑ r3 ❑� r ---- ------------------------------- Number of livingunits:___-_---___, umber of be'riaoms _3_' { Motel Other _ sdrbage Grinder�`- �Lot Size -- ------ Woter Supply: Public System and name ..----- Private Character of soil to a depth ofi3 feet: Sand'❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam F Hardpa.n:❑ Adob31 e_Q{- Fill.Materia! _• If..YeS,_tyPe =- -------------------------- (Plot •------(Plot plan, showing size of Int, location of system i elation to wells, buildings, etc. must_b placed cnN reverse side.) I NEW INSTALLATION: (No septic tank or seep pit permitted if public sewer is available within 200 feet,) r PACKAGE TREATMENT { ] -SEPTIC TANK'[ ? Size____. _�_{__.X_ -'________ Liquid sDepfih ___ -____________________ -S }! 6�� V Do Ca acct - G--------_- T �t�YfMaterial- �vR.i -- No. Compartments ___-___.- Y -1 Type p istance•--to•nearest:�Wel ,��--------------------Foundation _-_ _ p. C _-- ro .Line LEACHING LINE No. of Lines ___ ___._______ Length of each line_----17 — _______-_____ Total Length ---- I t --- _____- i Boxy Type�Filter Material n_n_.-_ Depth Filter Material _._ %_ ______________________________ Distance-to nearest i07e11 A ______________ Foundation _1�_��-____ Property Line. ------5--------- ....... � SEEPAGE PIT [ ] Depth -------------------- 'Diameter --------_------- Number ------------_------------- Rock Filled Yes ❑ No C A .. 1 -f_ Water Table Depth #----------- -----Rock Size -------------------------------- ` Distance to nearest:�1Nell ----------------------------------------Foundation -------------------- Prop. Line -------------------- -- D REPAIR/ADDITION(Prev. Sanitation Permit# ------------------------------------------ Date ____________r____________________) Septic Tank (Specify_Requir-ernents) -----------J_ yw-��iYr - -- ----- d DisposalField (Specify Requirements) ----------- ---------------------------------------------------------(-r---- --------------------------------------- --------------- = �Ll , :�- (/ 111 --------- ----s--------------------- _4 .--- rd------- -- ---- 1n 1 �'C1 RS � .��9_9v_15 _ _ Q� (Draw existing and required on revers side) _ '7`� - � I herebycern '� ..._ ._ .._ .�,�.,;--.��...,..-�..--.�_r_� •� fy lhat I have prepared this application and that the work will be done in accordance with-San Jaayuin County Ordinances, State Laws, and Rules and-Regulations of-the San`3 aquin Local-Nealtli District. Home owner or licen- sed a,&n s;sigiiature certifies the following._j "I certify that in the performance of the work for which this permit is issued, i shall not employ any person in such manner as to g become_ subject to,Workman's Compensation laws of California." Signed (� _ _ -------- -- ---- ---------------------------------------- Owner BY ----------- Title -------------------------------- (If other tRon owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY _-_-- -- --`_.L-- - DATE -- --- --- -- J!__ _____ BUILDING PERMIT ISSUED =--------------DATE -------------•--••--•--•---------•-------•- -- --------------------------------- - ADDITIONAL_COMMENTS ------------------------------ -------- ---------- - ` ---- --- ----- -- - -- ------ - --- -- - --- ----------------------------------------------------------- ___________ ________________________ -.-_- _ tl _- - -------------------- ______________ _____________________ ______ _ ._ _ _. ___-___- - - -! - "-------------------------------------------------------"- FinalInspec ------- ------ ---- --- ---- --- ---- ----- ---------------------------.Date -- ---------- ----------------------------- ----- -- -- - - SAN JOAQUIN LOCAL HEALT DISTRICT E. H. 9 1-'68 Rev. 5M