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FOR 0FFICF<US APPLICATION-FOR SANITATION PERMIT � �~ ---------------------------------- Permit No. - --------------------- (Complete in Triplicate) Date Issued - ------------v ----------------------------------------- ___ _________-______ This Permit Expires 1 Year from Date Issued Application is hereby made to the S n Joaquin Local Health District for a permit to construct and install the work herein described. This application.is made irk-compliance with C unty Ordinance No. 549 and existing Rules and Regulations: ' Crb l7YFf f Cali .I' { o / d JOB ADDRESS/LOCATION .--- ----- --- ----- ,,____ -L_ -a----------CENSUS TRACT ----------------�---�---- Owner's Name e JLN R --- --------- Phone Address -----------------PC f City -- A--V QLY_------- -C0^1A1--'----------------------- ; Contractor's Name --------- ------ ____ ---- -d--------- --------License #/40406--//----- Phone4b_(9,7b0 7--_- + Installation will serve. Residence ❑Apartment Houser❑ Commercial: Trtliler Court ;❑ i s Motel ❑Other -US.J------------- ------- -----�__._ s - n Number of living units_____________ Number of bedrooms _________Garbage rinde ------------- Lot Size _ __ _______ ______________________- Water Supply: Public System and nanie ----------------------------------------------- -------------------------------------------------------Private t f„ Character of soil to a depth of 3 feet: Sand SIIt❑j-.Clay#', ❑ Peat❑ Sandy Loom -❑ Clay Loam ❑ Hardpan E] Adobe'❑ Fill Allaterial __�l/ -'If' es type-t-- (Plot plan, showing size of lot, location of system in-relation,.to.welIs,�6uildings, etc, must be placed on reverse side.) NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) O i G— - :. 48,- ---------------- PACKAGE TREATMENT [ ] SEPTIC TANK Size K �"'� q p ' IX` Liquid De th� .: ------- 94 Capacity � _ At-_ Typ�+ _ Maferial7" _ No. Compartments. .--------........:.... r r------- �` � ' fps _.,..�y. . _... -� ��.. Distance to ne rest: Well �Q0___ ___________Foun Aon 'Q_____________ Prop. Line _ Q. .._._...... LEACHING LINE No, of Lines _J_--__------ Length of each li _ �- ------------- Total Length Z 0--•-------.-•-_ L�------ -r 'D' Box 10�- _ Type Filter Material t_z_ _____-__- .Depth Filter Material __I ____________________t______._.__._ Distance to nearest: Well : 00'__.------ Foundation _SZ7_r____.__-____ Property Line 1-0............... . SEEPAGE PIT [ ] Depth -------------------- Diameter ---------------- Number --------------------- --- Rock Filled Yes ❑ No i❑ Water Table Depth ---------------------------------------=--------Rock Size ------------------------ ---•--- Distance to nearest: Well ---------------------------------------Foundation -------------------- Prop. Line ______..__---------•-_ REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date __________________________________) SepticTank (Specify Requirements) -------- --------- -------------------------------------------------------------- ---------------------------_----------------------------- Disposal Field (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 ' the perfor nce of the wo54 for which this permit is issued, I shall not employ any person in such manner i as to becom s ject to Wr ma�Camp sation laws of California." Signed - ------- ------ ---- ------- -- Owner BY ------------- ---- -- ------------------- ------ -Title ------ - -- ---------------------------------------------------- - --- ---- ----- - - - - (If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ----------- ---R:nO--------------------------------------------------------------------- DATE ----- BUILDINGPERMIT ISSUED ---------------------------------------------------------------------------------------------------------DATE ---------------------------------------- -- ADDITIONALCOMMENTS ---- --- - ------------------------------ ---- ------------------------------------------------------------------------=-------- •---- --- - --------------- - ---- ---------- -- -------- ---------------------`- . ----- -- -- --------------------- -------------------------------------------------- --------------- --------------------- ------ --- - ----- ----- -- -- -- --------------------------------------------------------- ------ Final Inspection bY -------- ---- - - -- -- - ----- ---------------------------------------Date ------- . --- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M