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�v4 FOROFFICE USE: APPLICATION FOR SANITATION PERMIT ��,• w (Completi In Triplicate) Permit No. ...`.......- .f ..................•....................•......•......... - - F -Date ",Issued . ./..` . Thls Permit Expires 1 Year From 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: JOB ADDRESS/LOCATION ....; �. i�.s .�. -�s ..CENSUS TRACT ......---•...... ...... �. Owner's Name ....ee5 ,f........i.vlo./..n�S......................................I............. ---...:................Phone ............... ........ Address _... 0-'. .. L ... ..........:... ................City �� r Contractor'$ .....��.rC�:. ......Lica r k ... License' � .�•,S��X 2_1 Phone Installation will serve: Residence Apartment House C) Commercial QTraller Court 0 f . Motel Q Other................'........................ I Number of living units:---_-�..:. Nuiflb ,'of,bedrooms .:...Garbage Grinder ............ Lot Size .AW.X..3-.::; ............ Water Supply: Public System and name ...... ....,.. .......:.. ' ._j.....,....... .............................................Private Character of soil to a depth of 3 feet. Sand'Q Silt Q Clay,[} Peat.'O. Sandy Loom 0 Clay Loam Q a Adobe Flil Material .............if yes,type............... ............ (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse slde.1 NEW INSTALLATIONS (No septic tank or•seepage pit permitted if public sewer is available within 200 feet,} PACKAGE TREATMENT [ ]—.SEPTIC TANK( � Sive.................... .........:..:.............. Liquid Depth .................., s,l,c Capacity - ---------------•- Type .. :F. ........... Material..................:... No. Compartments ......................(A4 # r Distance to nearest: Well ....Foundation .. .. .. Prop. Line......................6 LEACHING LINE ( ] No. of Linea .. .f Length of each line. .XAZ—tTdtal Length .2.6...............4 Box Jcoo.:.. Type Filter Material .1-A A V...Depth Filter Material . c '................... Distance to nearest, Well _kV............ Foundation ........................ Property Line ........................ SEEPAGE PIT Depth .................... Olameter ..............:. Number ........... ................ hock Pilled Yes E3 No Q Water.Table Depth ................................................Rock Slze ................... 'Distance to nearest: Well ........................................Foundation .......... ....... Prop. Line ...................... REPAIR/ADDITION(Prev. Sanitation. Permit# ............. ... . Date a Septic Tank (Specify Requirements)._..:........................... ..................................................... .............................. P Disposal Field (Specify Requirements( ------ .� :....f.--••---1�1 �1t ..... .�........ .I............... .X. ...12. ... ........ `)4c.--- .�----- ��.. .004gd1vv:1��............... a ..-----......................... .--•---._---------------•-----.- = i(Draw existingandrequiredodditiononreversesde) 1 hereby certify that 1 have prepared this application and that the work will be .done in'accordance with Batt looquln County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health;District. Hoole owner or hoot. sed agents signature certifies the following: "I certify that In the performance of the work for'which this peratit is issued, I shall not employ any person in such manna as to become y9ect to Workman' ompensation laws of California." Signed .....------ :._.. i. IrC�l �? ..._ :.......... Owner BY j2 By --------•--••............... .... .r ---.. .__.f I�jd�/ r._................ Title ...... r� (if o#her than owner} T FOR DEPARTMENT USE ONLY APPLICATIONACCEPTED BY ------ -- ---- - -- ---•-•-----...........-----...-------..•---•--.......-...._•---.._.. .. DATE ,�........ ........... BUILDING PERMIT ISSUED ........... ............-.......................................DATE .... ..................... ........... ADDITIONAL COMMENTS ..................................................I......... ......... ._._....._....._.._.................... .-._..._..............:..........................- ----------1...111..------1111.. ----------------------------------------------- .----------- ............... ,... ,.._................,............. 4111 1111.. --�- .................................... ............................. -:-------------------------- N . I—................. --------- ----...-1111 _ . . Final Inspection b ....................DateEH 13 2 1-6Rev. SAN JOAQUIN LOCAL HEALTH DISTRICT 874 3M a