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'k FOR OFFIC�SE: '®`G APPLICATION FOR SANITATION PERMIT r -—A_5-f-------- -+ `-� .. _ i Permit No. ---- (Complete in Triplicate) ----------__---------------------------------------------- q ------------- This Permit 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 Yules and Regulations. JOB ADDRESS/LOCATION / 1, L��tr?Q- L��.E�-l� �-(,r,�l--fa6p �1 CNSUS TRAZ`T-.----- ---------- Owner's Name "e_,-VrA4---------------11 -- -----------Phone ------ i Address ---- '-------------- City --------------------------------------- Contractor's Name _,. License #,/ T _____ Phone - �r4G ,/e �--------------- ---------------- Installation will serve: " Residence P<Partment House-E] Commercial [Frailer Court ',❑ Motel ❑Other --__ !� ------------------------------------ Number of living units..__L____-- Number of bedrooms ------Garbage Grinder s Lot Size 1p2 ;rX--_� Water Supply: Public System and name ------------------------------------------------------------ --------------------------------------------------Privatex. Character of soil to a depth of 3 feet: Sand'❑ Silt❑ 'rClay ❑ Peat E] Sandy Loam -❑ Clay Loam '7 F Hardpan E] Adobe� Fill Material ------------ If yes, type ____________________________ � . (Plot plan, showing size of lot, location of system in rei.ation 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,) I Size-- y! X` lf -�f--f- --------------PACKAGE TREATMENT � SEPTIC TANK' Liquid Depth Capacity 42>4190---- Typej_ __ Material'AfVP416_`---- No. Compartments -----4....... _---- Distance to nearest: Well ----------_---------------__��k--___Foundation ____..______-_--_-__-_ Prop. Line ______-__--.:__-_____ El � � LEACHING LINE No. of Lines -- 2-_______________ Length of each line....;s��.______..____- Total Length ._ZW0,_ -__.----_____-- D' Box !_ Type Filter Material _Depth Filter Material ---------_______________.__-____-_ Distance to nearest: Well ._-- --49 ---------- Foundation _/W_-`--_--------- Property Line _40- SEEPAGE PITDepth -.v., �_�____ Diameter 139-------- Number -----Z--------- ---------- Rock Filled Yes No .0 ? . Water Table Depth --- ♦1-aIr---------`-------------------------Rock Size f----- `y- ----- Distance to nearest: Well ____ ___� ____ __________________Foundation .2C� -� -------- Prop. Line _N;f_.------ r. REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date ______-__________________________) Septic Tank (Specify Requirements) -----------------=------------------------------------------------=----------------------------•-----------------------.._.. Disposal Field (Specify Requirements) ----------_____ -__!l-______ F .F ___________________________________________________________________________,_______-__-____-________ ______________________________________________________________________________.____.____________ _________-___________________________-____._______ _________.._____________-____._____--.________-________ L ___________________________--------------.----------------------------------------------------------------------------------------------------------------------------------------------------- a (Draw existing and required addition on reverse side) 1 hereby ertify,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: ,T "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 Compensati laws ofiCalifornia." Signed --------------------------- ----- --- - ------ ---- -- 'S Owner x BY ---- ----- Title -------- L� - -----------------------'4- --- -- --------------- (If other th ner) t FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BYRQUL:----------------------�.......... DATE ~-°�-�l ----•------------------- 11 BUILDING PERMIT ISSUED ------ ------------ --------------------------DATE ----------------------------------------- ADDITIONAL COMMENTS -----------------------------------------------------it -- -- -- ---- - - -- - - - s Final Inspection by: _____ _ a _ Date ___ 0- ----- SAN JOAQUIN LOCAL HEALTH DISTRICT it i E. H. 9 1-'6$ Rev. 5M, �i