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FOR OFFICE USE: ` APPLICATION FOR SANITATION PERMIT `-------- � --`�----- (Complete In Triplicate) ............ ;.•' Date= ssued- .�r� �� i This Permit Expires li Year from Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and Initall` the worts herein described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS LOCATION .... .. f � .._ . ' .. ./ -,.. / ! ..........CENSUS TRACT .......................... . - ........ Owner's Name ......` .:.. .. .f,� .5.............................................11 -. .........Phone ..........----• cityAddress ] d. _ //iCr•4!� ...fry Contractor's Name ---.fl.�� .. crc1r. ..:..License.# ..: 'S .�3 Phone Installation will serve: Residence Apartment Housefl Commercial[]Trailer Court Q Mote Q tither................................. ...... .1 . Number of Irvin units•_._ Number of-L�ei1 Dams ••••• g •-__-- --�,.r.. ....Gdobage C�Ander-: .....:... 'Lot>Size . ...�.../..,�:,C:�. Water Supply: Public System and name ........ ....................................................Private Q Character of soil to a depth of 3 feet: ►Sand 0 Silt 0 CIaYPeat Q Sandy Loam fl Clay loam,0 I Hardpan❑ Adobe)K Fill Material ............If yes,type............... ............ e (Plot plan, showing size of lot, location of system in relation,to wells, buildings, etc. must be placed on reverse side.) NEW INSTALLATION: (No septic tank or seepage pit permittee-if public sewer Is available within 240 feet,) i ..............: � ...... .,,......PACKAGE TREATMENT I ] SEPTIC TANK I ] Size- -9--•.... Lt uid Depth �T� � . Capacity I-�00...... Type <-.4,- 4 Mater[al.... :... No. Com artments . Distance to nearest- Well ,r r --....._....I=oundation _-,/t�.•---....... Prop..Line fes.............. p , LEACHING LINE ( ] No. of Lines .*-_. ......!........ Lenbth of each line.../e_45?........r.... Total Length .../Q�:C`..... .©� Box4�.. Type Filter Material . �C/__ .Depth .filter Material .-f.�..........:............ i Distance to nearest: Well .AA6.A4f.._ Foundation _._ ......... Property Line ........................ SEEPAGE PIT f J Depth .. ...__. Diameter> ..• •-.--- Number ........./.I.....:.-......Rock Filled Yeas 0�---90 0T Water Table Depth -------- ......... Rock Size sa��l.-ZC:./....moi..... �. • ---..... 7 , Distance to nearest: Well .. . ..fit _ ..____-.- :I+ouradatlon _ ._':..._. Prop. Line . . ............. R>:PAlR/ADDITION(Prev. Sanitation Permit .:: =_:.. ..... :....... = ) =Date = - :......... ... . Septic Tank (Specify Requirements)............:.--•--••--......................................................:._._................---....................... .............� Disposal Field (Specify Requirements) -- 3. ' ? .-•. W "-a• ...................•-------.... .............. a ....._..____• ........................-----------------------------------------------_-•--------..._...__._....................._......................................_................................... 3 (Draw existing and required addition on reverse side) I hereby certify that 1 have prepared this application and that the work will be done In accordance with San Joaquin l County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local HeaIth:Dlstdct. Home owner or 11cen• sed agents signature certifies the following: "I certify that in the performance of the work forwhich this permit is issued, 11 shall not employ any person In such manner i as.to beco b(ect to Workman's:Compensation laws of California." : Signed ----- ...__ Owner s •',f lit other than ow er) R TMENT USE ONLY APPLICATION ACCEPTED-BY ------ ---- --- -- --- -- :•• -•-------------------------- .............. DATE ,-, .=f 6 :.------- ------ BUILDING PERMIT ISSUED-------- -- - -•-- . ..... . ........... ••-•-•--- -------------- -- ...--------.....DATE _..........__._.... ....................... ADDITIONALCOMMENTS ,-_ --- --. --- - ------ -------•- -- ..............................................................._.............................................. C _t�.••.• . .._... ......----------------------------------•--..........----...------ ........ ................::......._............. ..._ ._.. . .. . -------- -•----... .........•........................__._... r: --------... Final Ens ect'' n Is f ' EH 13 24 1-68 N J AQUIN LOCAs. HEALTH DISTRICT 8/74 3M