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FOR OFFICE USE: APPLICATION,FOR:,SANITATION PERMIT -----'--;'-----------'---- -- -'--•'---- _.�/--s`%�� (Complete in Triplicate) Permit No. ------------------------------------7_ _.____ I__-_ This Termit Expires 1 Year From Date Issued 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 applicationk:is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION 11._.-F 3_ ---PC---CPVn!g<---RYQ------------------- ---------CENSUS TRACT ---5_ ---------_---- Owner's Name ----------- PNj` - Cr2 .------------------------------------- ----------Phone.------------------------------------ �I Address ---------------f l u!---�/-------------------- -------------------------------------------- Cit -------------------------- --------------------------- I� Contractor's Name ---------'- --�i��.2. - - ------------------------------ ---.Li License # --------:--" - - Phone --------------------...------- Installation will serve: Residence �artment House❑ Commercial ❑Trailer Court ;❑ Motel ❑Other -------------------------------------------- Number of living units:.___�I"---- Number of bedrooms ---?v--__Garbage Grinder --- ----- Lot Size _____ACS_ ___________________ Water Supply: Public System and name ,-__[`�V;"_-WAT_Vm_ ---------------------------------------- E] ___________-_________ ________ Private ❑ ------------------------ Character of soil to a depthlof 3 feet:• Sand,,❑---Silt'❑• Clay ❑ Peat❑'� Sandy Loam ❑ Clay•Loam Hardpan ❑ i Adobe_❑ Fill Material __--------- If yes, type ____________________________ IPI'ot plan, showing size of lot, location of system in relation to wells, buildings, -etc:, must,be placed on reverse side.) m NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) ! - - PACKAGE TREATMENT [ SEPTIC TANK Size-------------�_24©Tl'"_�_. q }" Capacity __( ` r _j_'__:_ Type _- -i'� ___ Mafierial__ -__ No. Compartments _-__ ------- ,i � t Distance to nearest: Well ----1 _�________ r____-_______Foundation .._�.Q__.__._______ Prop. Line .__G LEACHING LINE [ I No. of Lines ----.__3-------------- Length of each line-----__SO------------- Total Length __AQ______________ 'D' Box ___. _- Type Filter Material _ __Depth Filter Material ------- _ _______________+__--__- Distance to nearest: Well _16CP------------- Foundation ------[b--------- .--- Property Line __17__7__-_____ - 1 SEEPAGE PIT [ ] Depth - ------------ Diameter ________________ Number _.-------------------------- Rock Filled Yes 0 No 0 4ater Table Depth ---------------------------------------=--------Rock Size -------------------------------- Distance to nearest: Well ----------------------------------------Foundation ---------._.-------- Prop. Line ---------.----.--_-•-_ REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date ----------_----------------------_) IN SepticTank (Specify Requirements) ------------------------------------------------------------------------------------------------------------------------------------------- Disposal Field (Specify I�equirements) --------------------------------------------------------------------------------------------------------------------- --------------- f__._,i________________'_____________-_________________-____________________ ____.___-________________________________-_____-___-_________.______._-____.__________ `1 _______ (Draw existing and required addition on reverse side) I hereby certify that I havelprepared 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, 1 shell not employ any person in such manner as to become subject to�W ,o rkman's Compensation laws of California." Signed �/ --------------------------------------------- Owner R I By ------------- --------------------------� -- - ---------- Title ------ - ----------------- (If other than olwnerJ II FOR DEPARTMENT U O Y APPLICATION ACCEPTED By ----------------------------- --- ---- DATE -----� = ------------------ BUILDINGPERMIT ISSUED -jl--------------------------------------------- ----- ------ --- - ------ --- -------- --------------DATE ------------------------------------------- ADDITIONALCOMMENTS Al------------------------------------------------------------------------------------------------------------------------------•------- .------- ----------------------------------------------------------------------------------------------------------------------------------------------------------- 1� ----------------------------------------------------------------------- - - ----------------------------- -------------------------------------------------------------------------------- --------------------------------- i ----- -- ------------- FinaInspection by-- -----------------------------------------------------------------------------'--------- - -- --------Date -------- - --'�--------------------------- SAN JOAQUIN LOCAL HEALT STRICT E. H. 9 1-'68 Rev. 5M.