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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT 4 �J__ <--------------------------�\ Permit No. �� 5 (Complete in Triplicate) _ _--__----__________________--_._--_-_--_____-_ This Permit Expires 1 Year Date Issued Date Issued ___g ------ Application is hereby made to the San Joaquin Local Health District for a permit to 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 _2.9 '7r__Z-�_,_-_-S_____A_I_F__P__©_R_1___-______-----A4-_t-_C4_-_CENSUS TRACT _____S'- _- ----- Owner's Name -----------M0,8R-1-----------R0_Q s---------------------------------------- ---- -------Phone ---9_23--315------ Address ----�_1?5_a----------------fl-R-Pj9-�'-------------------------- City _�--I-�-�------- --------------------------------------------------- Contractor's Name - /J�R----------------------------------------------------------License # ------------------------ Phone ----------------------------- Installation will serve: Residence [ Apartment House,❑-Commercial ❑Trailer.Court ;❑ Motel ❑Other ------------------------------- ----------- Number of living units:----I----_ Number of bedrooms _..�-----_Garbage Grinder/V�__ Lot Size ----!_4_CBEA-G�-------•-•- Water Supply: Public Syst7em and.name --------------------- ----- ---- --------- ----- --------- -------------Private Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat❑ Sandy Loam 25", Clay Loam ❑ Hardpan ❑ Adobe ❑ Fill Material y)E_5_ If yes,type ---;5/9N_ __Ly►19YV) • p (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 it permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK Size____�'f__�la_X_5-_______________- Liquid Depth -_ �` 7_---________- N Capacity ZI90------ Type FRB__, Material_C0_AAS% No. Compartments -_�....._-- Distance to nearest: Well _-______�---'i-=___________Foundation _1D___ -______ Prop. Line __S___{'__ LEACHING LINE K_".No. of Lines -------13 Length of each line-----710- ___--_____ Total Length ------:2`0---------- 'D' Box/-4-=5-'Type Filter Material tg0_0<____Depth Filter Material ______�9______..____ _________________ Distance to nearest: Well ____ �____-,t-____ Foundation ----- _ _---'�_____ Property Line -i- Distance ` � Pro ---�-`-------•-•--- 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 Rufes and Regulations of the San Joaquin Local Health District. Home owner or licen- sed agents signature certifies the f lowing: "I certify th t i the performanc f the work for which this permit is issued,1 shall not employ any person i)t'such manner as to beco bject td Workm 's Compensation laws of California." Signed o- - ` .. Owner'-------------------------- By ----- -------- --------- ----- - ------- - ------ -- -- Title --------------------------- -------- ----- ----- ------------ (If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY -_- cR_-_C� _______. DATE _-___ ----------------------------------------------------- BUILDING PERMIT ISSUED --------------- ________--- -DATE ------------- ----------------------------- ADDITIONAL COMMENTS --- ---- ------------------------------- - ---- -- - - ------------------ ---- -), ----------------- - ---- --- - f ' - - .-. � Final Inspection y: __ _ --- -- - ` --- _, -- Date -- - -- - -- - -- -- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M 7 Pim