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EOR OFFICE USE: APPLICATION FOR SANITATION PERMIT 41f - - -------- --- -- -A --- (Complete in Triplicate) Permit No. ------------------------ This Pe?mit 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 application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION .307-41-1-------S- -------JQJ RR ---CENSUS TRACT ___,__&_ _____________ Owner's Name RNTCI �f?RTxf� �� L �- ---- Phone10 '- - rte jL Address ---------/�_ - o ----4f 1�-04a4--.- `-- ------- -------•--. City -- ----- --- ------------------- Contractor's Name-------0-W f�------------------------------------------------------ ----License # ------------- ------ phone ---_----- ,Anstallation will serve: Residence ❑Apartment House❑ Commercial .[]Trailer Court Motel ❑Other B ---140-V$�----- Number of living units:------------- Number of bedrooms ------------Garbage Grinder 49---- Lot Size _. RIS-------•___• Water Supply: Public System and name ---------------------- --------- ------Private Li� Character of soil to a depth of 3 feet: Sand'❑ Silt❑ :Clay ❑ Peat Sandy Loam� Clay Loam ❑ Hardpan ❑ Adobe [I Fill Material -AI'---- 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 sewer is available within 200 feet,) G, PACKAGE TREATMENT [ ] SEPTIC TANK [rj� Size____ _ IO__X_`'�__- :- Liquid Depth _____ '? ---- Capacity _ Z0_Q__.__ Type PRE_�� Material-CO R.: - No. CompartmentsnO Distance to nearest: Well ___________________5-Q__.____Foundation ----------/0 prop. Line -_------ ____....... ✓ � f LEACHING LINE [*, No. of Lines -__-_-__-___---/----- Length of each lin e_-_--_-__-/00--____ Total Length ,_,__-.. .......... \ e� 'D' Box -F7�5 Type Filter Material R©�C>II�---Depth Filter Material ----)—:__-------------- ................... Distance to nearest: Well ---------- ----- Foundation ------------tO----- Property Line ---------------------- SEEPAGE ------- _____ ____SEEPAGE PIT [ ] Depth -------------------- Diameter ________________ Number ----------------------------- Rock Filled Yes ❑ No 0 WaterTable Depth ------------------------------------------------Rock Size -- ---=-- ----------------•---- Distance to nearest: Well --------------------______________________Foundation -------------------- Prop: Line ...................... REPAIR/ADDITION(Prev.Sanitation Permit# --- Date ---------------------------------- Septic _______-______________________ -Septic Tank (Specify Requirements) -------------------------------------- ------- -----------------1-----------•----------------- 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 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 -------- ------------ - ------ -- ------------------------------------- ------ Owner By -- --- - - ----------------------------- ------------------------ Title -- - ---------------------- (I er than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY -----1-i-R--q------------------------------------------------------------------------------ - DATE ----- --------- ---- BUILDING PERMIT ISSUED --- - ----- --- -- - -- --------------------------------------------------DATE ------------------------------------------- ADDITIONAL -- ------------------- ----------------ADDITIONAL COMMENTS ------------ - - '---- ---------- - ---- -- ---- -- ------ - ------- - --- ------------ �' _ _ _ _ _ _ _ _ _ _F_____ __ ___ _- ___ J Final Inca b `',� -- -- ---------- Date _ _. _ '" /-�� $' ---- ''� SAN AQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M