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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT -� � Permit No, /_ C�S� (Complete in Triplicate) Date Issued ------------------------- - ------- This This 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 Ry (.�--_r � 1 JOB ADDRESS/LOCAION Rules and Regulations: ------ ------- .1� ------------ --------------CENSUS RTAC ------- ^-___- ___��-- - -�^ Owner's Name --- - "------------------------------- �--- �-_-�- -Phone ------------------------------------ Address ---- `' `=U -- City `-------------------------------------- Contractor's Name _1- Z) - --------License # � �` _ Phone --- �-- Installation will serve: Residence partment House❑ Commercial ❑Trailer Court ;❑ Motel ❑Other -------------------------------------------- Number of living units:--- Number bedr o ____Garbo a Grin r _. ___ .� Lot Size _ ------_- _4_..L�1___-s--------_-- Water Supply: Public System and name ___ ____�____. ----------------- -----Private ❑ Ga eat Sand Loam Clay Loam ❑ Character of soil to a depth of 3 feet: Sand❑ S ❑ y ❑ ❑ Y ❑ Hardpan ❑ Adobe EtX Material ----- ------ If yes,type -.__-.-....____._-_-____ (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) Lo NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) SEPTIC TANKSizes __ __NTLiquid �L-- ----,----- i PACKAGE TREATME -2 ,� -_____._ De th Capacity ..... Type _ Materialat; t__r:Co. Compartments ----^'— ....... Distance to nearest: Well '- �" _--__-_-Foundation ._ _-��__.`_.__.... Prop. Line _.. -.:--_.---._ LEACHING LINE No. of Lines .____-t�c-___-__ Length of each line-____ G'_ Total Length (_ ................... 'D' Box _--... Type Filter Material��I-_3___!p f&pth Filter Material _.-r. ---------------------------------- -1 �� Distance�b ne rest: Well --------------_-_ Foundation _.... --------- Property Line � ....... ............�'` SEEPAGE PIT Depth -- Diameter ti. -_`__.._. Number __ --_____._,`..___- Rock Filled Yes '�o 0GG Water Table Depth -----�_Q__-/-------------------------------Rock Size _// ---`--_------------ l Distance to nearest: Well ____.-_- ---------_-------Foundation - �%-_./.... Prop. Line 15.....J--........--- REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date ----------------------------------11 Septic Tank (Specify Requirements) ---------------- -- ------------------------ ---------------------_--- DisposalField (Specify Requirements) ------------------------------------------------------------------------------------------------------------------------- ----------- ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ------------------- ----------------— ------------------------------------------------------------- - ---------------------------------------------------------------------------------------------------------------------------------------- (Draw existing and required addition on reverse side) 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 shall not employ any person in such manner as to become subject to Workman's Compensation laws of California." Signed --------------- --------------- �_ / Owner---------2` � Title ---G/cam -------------------------------- ot er than owner) F ARTMENT USE ONLY /� APPLICATION ACCEPTED BY ---- ---- --- --- - -- - ---------------- ------------------------------------- DATE ------ -2 -_---1/�{�------------ BUILDINGPERMIT ISSUED --- -- ----- ----- ---------- ----------------------------------------- -------------DATE ---------------------------------•--------- ADDITIONALCOMMENTS ----- ---- ------------------------------------------------------------------------------- ----=---------- ---------------- -------------- - --- - - - - ------- -------- -- -------------------------------------------------------------------------------------------------------------------- /- - --- + t--- -- ------------------------ ------------------------------------------------------------------------------------------------ ---- - ------ - - -- - - --- - -- -- - ----- -- - - -- --- - ---------- ----- ------- ---------------------------- ----------------------------------------------------- -------------------- Fi al Inspection by: --------------- - ------ / -------Date ' ------------------ J QUIN AQUIN LOCAL HEALTH DISTRICT J E. H. 9 1-'68 Rev. 5M