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FDR OFFICE USE. APPLICATION FOR SANITATION PERMIT '�� 312V ......................•. --•--------- ................. Permit No. ..................... ............................................... {Complete in Triplicate) ..... This Permit Expires I 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. 549 and existing Rules and Regulations: St,.A' CENSUS TRACT . JOB ADDRM/LOCATION ...... -1. --Q..--- •----rr ?_�r.��y --- - ..... Owner's Name � ' .....Phone Address D S. ..: .. .•_.._.._ ,. / ..... Contractors Name ._h'X9-1&1, .............J�t/2_ Icense Phone Installation will. serve: Residence fig Apartment H mmemial❑Trailer Court ❑ Motel 0 Other-----•-••---•--•--••---------------=------- Number of living units:_._ Number of bedrooms .,3...__Garbdge Grinder Lot Size _ _71...... `----- ��!Q • Water Supply: Public System and name Private Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat 0 Sandy Loam (j Clay Loam ❑ Hardpan C7 Adobe 5) Fill Material ............If yes,type ..•...........:. ............ (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be plated on reverse side.) NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT SEPTIC TANK . Size............................................... Liquid epth Capacity J1b.D_.....JType ...... ............. ..G�;._..._........._:. No. Compartments :�_....�..._..... .,� Distance.to nearest: Well --7.5:..........................Foundation ...................... Prop. Line ._ .. ........... . LEACHING LINE No. of Lines R [ ] �-------••----_--. length of each line..-.�.5.. •............ Total Length _110.................. 0 .D. Box -Z-- IDG �� - hi.. .........:.... Pro.e. ..............._._...... ...... ____ Type .Filter Material � _.__� Depth Filter Material �.. Distance to nearest. Well _----_-_---_ Foundation p rty Linep Rock Filled Yes No SEEPAGE PIT [ } Depth 96.x........ Diameter -- �_ __ Number ...�-----------------`r � .-Rock Size .. ..!/.................. Water Table Depth ------------.................. :.. _. .__.. .� Distance to nearest: Well __ . !l __.� ................Foundation . -©.t --•-- Prop. Line . ?ice?-t-.••7 REPAIR/ADDITION(Prev. Sanitation Permit# ............._........................=•---- Date ...:........................ .......) Septic Tank (Specify Requirements). ..............................................•--._:.._ --•----• ------ ............. ......--•......... 1 Disposalfield (Specify Requirements) ----------------•----•- -................................ ............................................... ......... ........ ....... } ---------------------------------------------------------- -----•--••--•-•-------------------......................................... ------------------•---- . ................. •--•••---- ........................ ------------------------------------------------------------------ --------- - .... ................ .................................................. . . (Draw existing and required addition on reverse sidel 4 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 that in the performance of the work for which this permit is issued, I shalt not employ any person in such manner as to-become ublect to Wo *man's C pensation laws of California," Signed -----��tE• f .....---- Owner _. _ . y" Bt�-_... -•........................... ........................... Title ......G (if other than owner) �. 42 FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED. BY - -_---_-_---_------•------- -------------------------- DATE AK.7�Y,-?X------------------ BUILDINGPERMIT ISSUED -----.:...._:------------------------------- ------.-._..------------------------- :..._.....------.DATE ..... . --------..........--- ....... ADDITIONALCOMMENTS ..-----•._-----.................•-•--...--•--•-••----------- _----••,•••--••..-.-_----- -----...---.._._......_.. .... --------------..-----...._.__--•-•-- ...............- -- -------•------- ---------------------------------•-------------------•---------•----- -•-------------...------------- ------- --. ---------- ------ r ------I— ------- Finai inspection by- '"�• '' - •------------------------•-----•-..........._._._.......-- ---_._._Date _.�!'r�T� t ... EH 13 21; 1-68 Irv, 5M SAN JOAQUIN LOCAL HEALTH DISTRICT 8/7h 3M