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FOR OFFICE USE: II APPLICATION FOR SANITATION PERMIT • `-•-•°—•'._..------Permit No:'--7 1-- 01. (Complete in Triplicate) Date Issued This Permit Expires 1 Year From Date Issued ----------- ----- Application is hereby made to the San Joaquin Local!Health Distriat far .�er - to construct and install the work herein described. This appl-ication is,made.in-compliance with County Ordinance No. 5�9 and existing Rules and Regulations: I,� rte... -._ i _ JOB ADDRESS/LOCATION !Y.--co __V -- - --__._- CENSUS TRACT -------------- ._..___. Owner's Name Il ' '! L.-,r---- � ------------------Phone Address ------ Q - -- _ Contractor's Name _.: X 0411/---------------- -----------------------------------------license ;:Z4__1Phone �----_- . Installation will serve: Residence vx1partment House❑ Commer'ial ]Trailer Court ;[ , l i Motel ❑ Other 1----------------------------------=-------- r x'" t Number of living units:_ !-______ Number of bedrooms; '__~_Garbage Grinders` I_ot,Size __7°_ _____X-_�©- -________ Water Supply: Publi System and name ' Private [ � : Character of soil to a,depth of 3 feet: Sand' �illF] Clay ❑ Peat ❑ Sandy Loam ❑ Clay Loam :❑ i .��.. Hardpan_❑k, sAdobe ❑ Fill Material ------------ iftype ----------------------------- (Plot plan, showing; size of lot, location of system in relation to wells, buildings, etc, must be placed on reverse side.) 1.NEW INSTALLATION:'. (No septic tank or seeps # pit permittedifpubic sewer is availably�ithin 200 feet,) PACKAGE TREATMENT f ] SEPTIC TANK [ Size_/___' __X _"7` ___ Liquid Depth .____'___.____ I Capacity/IZ9Q------- Typ`e�:_�_ Material1C4Z� No. Compartments ................ i Distance to nearest: Well _ ' �________________________Foundati n _IQ-__--_--- ___ Prop. Line bir_______. LEACHING LINE 11411 No. of Lines __ t' ----------- `1'Length of each line.20------------------ Tota! Length 16- -_-_--__-----_. t � S ,k © tom i D' Box ___________ Type Filter Nlatenal�_��______Depth Filter Material �_7______________________________._...... -_ J 'r e Distdnce" o nearest: Well t ff! u a- Foundation f_L_ _____-_--_-Property Line..5------------------- le _ SEEPAGE PIT Depth L / m __ __ _____ _ Rock File Yes [ No ❑me t Water Table Depth ------------.---------------------------------Rock Size - --_-- T' Distance to-nearest: Well _- �_______________-------------Foundation � ____._.___ Prop. Line- _._.__ -------- f REPAIR/ADDITION(Prev. Sonitati'bin"Permit# -------------------------------------------- Date ---------_-----------------------_) �s Septic Tank (Specify Requirements) -------------- ------------------------------------------------------------------------------------------------------------------------------ Disposal ---------------------------Dis osal Field (Specify Requirements) ------ ----------------------- ai ---------------------------------------------------------- (Draw existing and required addition onvrewerse_side) �, I hereby certify that I have.prepared this application and that the work will be done 'in.raccordance with San Joaquin County Ordinances, State taws, and Rules and Regulations of the San Joaquin Local Health IDistiict.)Rome owner or licen- sed agents signature certifiesthe following: ' 1 "I certify that in the performance of the work for which this permit s isstied, 1 shall not employ'anyF person in such manner as to become subject to Workman's Compensation laws of California." i Signed T -. � - Owner ------- ------ ------- --------------------- -- ----- By ---=---- e-- -------- ==------------------- Title Q, 1�,.�'WAl_j (If other than owner) I FOR DEPARTMENT USE ONLY ll y APPLICATION ACCEPTED BY ------------------ ------------------------------------------------------------------------------------, DATE !� -------- r BUILDING PERMIT ISSUED ------------------ ------ - - - ---------------------------------------------=--------------DATE --------------- --------------------------- ADDITIONAL COMMENTS --- ------------------------------- ---- --------------=------------ -------------• G. ---- - ------------------------------------- --- t ------------------------------- - --------- - - -------------- -------- ------- ---- --- - - ---- - --- ---- ------ - --- .. - --- __._ - - -- - -- - - ---- Final lnspec F ---------- ------------ -- - -.Date -- �------ ---------- --- --- �- - -- • t SAN.JOAQUIN.LOCAL HEALTH DISTRICT ; E. H. 9 1-'68 Rev. 5M .i