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FOR OFFICE USE: 0 ` 's+ AtPLICATION FOR SANITATION PERMIT b--f� -• 0 -p---------- - -�________- (Complete in Triplicate) Per it No. ---------=---------------------------------------------- This Permit Expires 1 Year From Date Issued Date Issued .GrfS_�Zp 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. 5.49 and existing Rules and Regulations: JOB ADDRESS/LOCATI N . ? S - . ,�`D 4.k_ _CENSUS TRACT - __________._ Owner's Name :-------- tw i7�% -----�f'''_.`!1 �---------------- ------------- - -----Phone ------------------------------------ - - Address -------------- l-_ > r�' 15 ` -------------------- City -CGrC� Contractor's Name -------- -- - .- - --------------------------=--------License #140 Phone Installation will serve: Residence [Apartment House,[:] Commercial:❑Trailer Court ;❑ Motel�❑Other ----- Number of living units:.__---__ Number 6edraoms � ---------------- Water Supply: Public System and name _ !/-49,ef e,---l9'a -Ua� -- ---------------------------------------- ----Private ❑ Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay .❑ Peat ❑ Sandy Loam ❑ Clay Loam'' i Hardpan ❑ Adobe 'F Fill Material ------------ If yes,type ---------------------'_----- I (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 permitted if public sewer is available within 200 feet,) �� v p PACKAGE TREATMENT I ] SEPTIC TANK'[ i e_-- _ - -_-_- __._-----._ Liquid Depth%__-T! _ ------------ CapacCapacity --/--��-,-- Typ 1u _ -_--------- Material o. Compartments ------ ---------- ity --/-,? .......... .... Distance to nearest. Well -__.-_ "�------------ -.---.-_-_ p. Line) --Foundation - _-- _-- Pro Linel-— LINE [, ' No. of Lines ----rte,----------- Length of each line_ .5 _ ----fir Total Length ;__� -..._-__---- 'D' Box Type Filter Material _��- ��--Depth Filter Material/ ---_----_--_---__------------------ 14s Distance o nearest: Well ------- --- Foundation f-_d.....------------ Property line __ -----_-_-._-.-. ' f � i SEEPAGE PIT (1/( Depth __r -_�-- __- Diameter ------ Number -------c_� -------_--- Rock Filled ,Yes No ❑ Water Table -Depth ---------7!7_0-------------------- --------Rock Size --/---1�:-�'.�- - • i r � Distance to nearest: Well -_--------- -----------------Foundation ---e Prop. Line _,.57/.---__-. REPAIR/ADDITION(Prev. Sanitation Permit# ------------------------------------------- Date ---------------------------------- Septic ---------------------- -----Septic Tank (Specify Requirements) -------- -- --- ------------------------------------- ---- --- --- -----------------:---------------_---------------------------- Disposal Field {Specify Requirements) ----------------------------------------------------- `----------------------------------'-----------•----------"---- " � d ---- -------- J ___----------------"------------------------------------ ----------__--____________-_--_-_-----------------'--------- ----"---"--------,-------- i(Draw existing and required addition on reverse side) - a I hereby certify that I have prepared this application and that the work will be donein accordance with San Joaquin County Ordinances, State Laws, avid Rules and Regulations of the San Joaquin Local rHealth 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, 1 shall not employ any person in such manner as to become subject to Workman's Compensation laws of California." Signed -- ------------- ----- --- --------------------------------------------- Owner %� r oeGzj � ✓ B ------------ ------ -----•------------------------ Title ----- ----------- By r - --- --- ----- -------------------------------------------- ( oth t an owner! 4 _4,4--)1"e;?AVARTMENT USE ONLY �* . APPLICATION ACCEPTED BY --------- --- DATE A BUILDING PERMIT ISSUED -------- ` ----_----:----✓--------- � ------------------- ADDITIONAL CO MENTS _ - - -- ----- -- -- --- , .... __ 2 -- - - ---------------------------------------------------- .40-07 -- ---------- - - - - ----11-*tv �elh--------�_u-�- ----d^,1..... + ----------------------- - - -- --- - -- --- ------ ---- ---------------- ------ ---�- ----------------------------------- --------- - ----- ------- -- - ----------------------------------------- ------------------ -- :Final Inspection by: . - --------------------------------------------------- -------------------.Date �1/r-'�/ JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'G8 v. 5M