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41 FOR OFFICE .USE-- ..� 't APPLICATION FOR SANITATION PERMIT Permit No. 40:7�0l •-------------------------------------------------- (Complete in Triplicate) --_1-------- -1-A --------------- This Permit Expires I Year From Date Issued Date issued -------------- --------------- San Joaquin Local Health District for a permit to construct and install the work herein Application is hereby made to the ance with County Ordinance No. 549 and existing Rules and Regulations. described. This application is made in compli _83 1 ---- -- ---CENSUS TRACT ----------- JOB ADDRESS/LOCATION ------- Owner'A Name ------K I--1114--d-AUE I-Src,/VS ZQ1"-_fP------I---------- ---------------- -------------Phone - ---------------------------------- Owner's ----------------------- --------_.. city -71- ---------------- ------------------------------------------- Contractor's Name ---------MURv�-----Qo(X_)4D1Z I---------License # ---- Phone Installation will serve. Residence [�partment Housef-I Commercial :E]Trail6r Court [1 Motel F-l Other -------------------------------------------- _)o---- Lot Size Number of living units:--- ---/--- Number of bedrooms ---3-----Garba-ge Grinder -A -------Private Water Supply: Public System and name ------------------------------------------------------------------------------------------------------- CT&T�i'6'cter of so![ to a depth of 3 feet. Sand'E] Silt El Clay 0 Peat E] Sandy Loam C] Clay Loam.0 ------------ Hardpan F1 Adobe [kFill Material ------------ If yes, type ---------------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side4- Q NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) N PACKAGE TREATMENT SEPTIC TANK Size--- ......5 Depth ----- ------------ Liquid t --- ----------- Capacity 1ROO-$5)__ Type _&C Material- a��Y)Crele_ No. Compartments Well --------"----------Foundation ....JO------------ Prop. Line _55............ lCa Distance to nearest; W ,-q ---- Total Length ___ --------•--•-- LEACHING LINE No. of Lines ---- -------- Length of each line 'D' Box ye-1---- Type Filter Material fk-.---Depth Filter Material ---- ----------------- ropdfty' Line ---- ------------------- .176unclatcon—_10--------------- P' Number ------(:��-------- Rock Filled YesA No 0 SEEPAGE PIT Depth 10------------- DtmwMer p � Water Table Depth --------- 0- -Rock Size J ------------------------ Distance to nearest. Well ----/W------- ---------------------Foundation __6s---------- Prop. Line ......5q-------- REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date ----------------------------------) Septic Tank (Specify Requirements) -- ----------------- ------------------------------------------------------------------------ -----------------, Disposal Field (Specify Requirements) -------------------------------------------------------------------------------------------------------------------------- -------------- ------------------------ -------------------------------------- -------------------------------------- -------------------------------------- ----------------------------------------------- ------------------- ---- d (Draw existing and required addition on reve rse s I e with Son Joaquin y certify that I have prepared this application and that the work will be done in accordance wil I hereby I 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 --W____ ------ ------------- -/----------------------------- Owner By -------------------------- Title -------------------- -------------- -------------------------I---------- --------- - lif other than owner) FOR DEPARTMEN 0 � APPLICATION ACCEPTED BY ---------------------------------------- ----------- - - ------ --------- --- AT ----G' i41 --------------------- BUILDINGPERMIT ISSUED ------------------------- --- ---------- ----------- ------ -- ---- -- -- - --------- ------------ - ATE ------------------------------------------- ------- ----------------------- -- ------------------------------------------------------- ADDITIONAL COMMENTS -- ------------------------------------- -------- -------------- -- ------------------ ----------------------------------------- --- -------------------- -------------------------------------------------------------------------------------------------------------- - -------- ------ --- -- ------------------- ------------------------------ ------------------------------------------ - ---------I----------------------- ----------------------------------------------------------------- -- ---------- --------- - - ----------------- - -- ---------- ------- Fin.al ln'ipecti6n by: ------------------- ---------------------------------------- ---------- Date - - ------------------ SAN JOAQUI AL HE T D ICT E. H. 9 1268 Rev. 5M.