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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT --------------------------------------------------------- Permit No - .-------- - (Complete in Triplicate) -- --------- -------- 8 7 /` ------------------- - --.t_____-__- -_____-___ This Permit Expires 1 Year From Da#e`>ssued Date Issuedl ... Application is hereby made to the San Joaquin Local Health District for a permit tol 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 .F�� _ ------�-_fiVfWA------------ _- _ CENSUS TRACT __.�`1_/ ____•____ Owner's Name ------r-rus----------VA-NPC-K---... . 70 - -------Phone --------------------- - -.-.-.-.-.-.-.-.-.-.- . Name- -----F -----1 i� --------------------------- City - JE;cO -/V---------------------- ®� Contractor's Name _ 11((,�_..cc�----- HOER\ 1-CE ._ License # 9��-9- ---_ Phone 9#7__l�1_-1-�_.__ Installation will server f it�f PResidennceKK Apartment Ho sseLE] Commercial Trailer Court Motel ❑Other -------- ----------------------------------- Number of living units:______,___ Number of bedrooms __ __--Garbage Grinder _ Lot Size Water Supply: Public System and name :_ _______: 1r_________________PrIvate Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑µ Peat❑ Sandy Loam E] Clay Loam Hardpan [Adobe E] Fill Material - If yes, type ___________________-_-___ (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. mint be placed on reverse side.) NEW INSTALLATION: (No septic tank or seepa pit permitted if public sewer is available-witfhin 200 feet,) ' PACKAGE TREATMENT { ] SEPTIC TANK Size__ - X ------------------ Liquid Depth ._-------___-___-•__-_.___ Capacity _11,606----- Type? EC�-ST-Material_Cp/Y�CP-%7--No. Compartments --�.___.___-. istance to nearest: Well ----/1 _/'f_—__________-Foundation ��_--_ -4— /0. -___ Prop. Line __,�..."�...__j✓ �__--__, Total Length _� __._� � LEACHING LINE-, No. of Lines ___�--__________ Length of each line_______. g _ __...__.. O 'D' Box/.F-5 Type Filter Material Q� _Depth Filter Material ______ c r ,r 110--1-4— f Distance to nearest: Well -101(2__' ----- Foundation /,0_ -4-- Property Line :_ SEEPAGE PIT Depth __!_'--/-__________ DiameterX__�-�:• Number ____-�__-__ -___--_____ Rock F'lled Yes No is ' ` - Size --� --�---�---� ---Z=-� � o Distance to nearest: Well --------1edJ '7..._.....Foundation __a _'� __ Prop. Line __` _._'i....._ REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date -_-__________._____-__.___.._____) Septic Tank (Specify Requirements) ------- ----.--- --------------------------------------- ---- -----------------------y--------------------- Disposal Field (Specify Requirements) ------------ ........ / _--------3---------W/Q,�--- _ 2-0 to ----�"'__. ----- ------------ ---------------------------------------------- ------------------------------------------- ---- --------------------------------------------------------------------------------------- (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 Mules and Regulations of the San Joaquin Local Health District. Home owner or licen- sed agents signature certifies the following: "I certify Lnheperfo rmanc of lie work for which this permit is issued, I shall not employ any person in such manner as to be t to rkm 's ompen on laws of California." Signed ---- - C ..S Owner BY ----------------------------------------------------------------------�-0-1 ----- Title -------------------------------------- --------------------------------- (If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ----T RX----------------- ----------------------------------------------------------- DATE ... - -- --- ------------------ BUILDING PERMIT ISSUED ---------------- --------------------------------------------------------------------------------------DATE --------------- -------------------------.. ADDITIONALCOMMENTS - ---------------------------------------------------------------------------------------------------- ------------= ------------------- -----------------, -------- -------- -------- ---- --- - - ------------------- ------- ---- - - -- - ----------------- - ------------------------ -- - -- Final Inspection - -- ---s Date f {-- ----- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M