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FOR OFFICE USE: .,, 36 - 3 r Z/ APPLICATION FOR SANITATION PERMIT, -„ l [ (Complete in Tri iitate Permit No, .7.._...........__. P ) '},' ''}..... ....--- Date Issued ._ "/T 77 r k ------------------................ This Permit Expires 4 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 t described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations. ► JOB ADDRESS/1-OCA T ON .. �. �- ENSLIS TRACT ............ ........ . . G Owner's Name ... ..� C_ Q.. ...... .. .....Phone a ............... ......... .............................:city . ._.��.�..�... /.........._._1��.,�.� } Contractor's Name _._ :_. '"2 ,1= ._ ...............License tl`-'�5�17..3.. Phone Installation will serve: Residence[]Apartment Housefl Commercial❑Trailer Court Motel ❑Other_ - •--., Number of living units:------------ Number of bedrooms ------------ Grinder Lot Size Water Supply: Public System and name .............. Private Character of soil to a depth of 3 feet: Sand Silt❑ Clay ❑ Peat❑ Sandy Loom ❑ Clay Loam i Hardpan Adobe l] Fill 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.) NEW INSTALLATION: (No septic tank or seepage pit ,permitted if public-/ewer is available within 200 feet,) PACKAGE TREATMENT ( I SEPTIC TANK � ] Six �.1,�:.�Q..__XZ .._.^....y-Liquid Depth -... _. .. . Capacity -lBepa-... Typ daS7"-Material--��,rLJ.:..._ No. Compartments Distance. to nearest: Well ..__..00. .. ........ .__ 10............ Prop. Line ...... ...`...... .. LEACHING LINE ] No. of Lines /.Q__-------- Length of each line_:._/Q ......... Total Length -/.-'O.O.0........... xJ � AV: .v D' Box . --•- Type Filter Material ....-�'..,..--_--.Depth .Filter Material ..../,.'�.._. .. 7 � ...............-- ........ Distance to nearest: Well _- 3 _ Foundation _._.. D-----.� � " � - - ..._.... Property Line ._.�..-•-----....--tb ; SEEPAGE PIT `� ..__..... Rock Filled Yeso No (3 Depth __��.._--.... Diameter .�.3.__--.. Number .__-.•��-•---- Water Table Depth ........... • -----•---•................Rock Size Distance to nearest: Well -----------..... ........Foundation ............:....... Prop. Line -•-•--••--•- REPAIR/ADDITION(Prev. Sanitation Permit# ---------------------------------------- Date ._...:_._---. ........ Septic Tank (Specify Requirements) ...................... . — Disposal Field (Specify Requirements) .__.............. ! -----------------•----------------•------,...._ r raw existing and required addition on reverse side) I hereby certify that I have prepared this application and that the work will be done In n accordance with San .teaqul County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health:Dish dact. Herne owner er qui 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 beta subject to Workman's Compensation laws of California:" Signed -`-•------------- Owner BY ------------------- �- -A--- - --- - .. ..---•--.. Title • .. : a# tan ownerl r FO DEPARTMENT USE ONLY APPLICATION ACCEPTED BY -- -.--- r t BUILDING PERMIT ISSUED __..... -----._.,DATE �...`,� ---------- ITIONAL COMMENTS ------------------- -- --------DATE .-•---- ---------- --------------•--------- --------------••- -- ................... .............----------------------- --------------•-------•---------------------------------------------------•........ ............. Final Inspection b ------------...:............•--•--._........__.....--•• --- ----......... EH 13 2L 1-68 }iev. � Date -.1-..�r?--:`,2........... ... I JOAQUIN LOCAL HEALTH DISTRICT 87)1 3M r