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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT 7` Permit No. --------------------------------------------------------- (Complete in Triplicate) ---------=----------------------------------------------- / Date Issued -------------------------------------------------- This Permit Expires 1 Year From 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: 2--57?5 S - ----------------------- CENSUS TRACT ---�-'-�------ -- JOB ADDRESS/LOCATION .�P)7I5QIU._ S'- -- -- -- ------ Owner's Name -------------- ---Phone----------------- Address -------------------- --- R t14 ft ---------------------- Cit ----------------•-------------- Contractor . Name TTR.---NM_C.I�-pp'i-t0,-------------------- "F-S------.License # ----- Phone --- Installation will serve: Residence ❑� artment House F1 Commercial []Trailer Court ;j] Motel Cher __SaID!___� �� _.Garbage Grinder / -- Lot Size _____-1- _. ----•------•- -1 Number of living units:.k/4- Number of bedrooms Water Supply: Public System and name ----------------------- ------ ------•------------------------ -----------Private [ ,11 Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam g4- -- V) Hardpan ❑ Adobe ❑ Fill Material ---- If yes, type ---------------------------- L]w (Plot plan, showing size of lot, location of system in relation to wells, 41 s, etc, must be placed on reverse side. NEW INSTALLATION: (No septic tank or seepage pit per n ifit�d if pubic sewer is v, 'lable within 200 feet,) PACKAGE TREATMENT [e] SEPTIC TANK Size. "_l ___ '�tZ - '___________- Liquid Depth _ ��_____________ Capacity 19 Type - -- - - --------- ---------------------- No. Compartments - �------------- Distance to nearest: Well ---16M________________------Foundation ---16--.--------- Prop. Line ----- ------ LEACHING LINE j ] No. of Lines ------V-------------- Length of each line------------------------.--- Total Length -aa ----------_..- - 'D' Box ._- __ Type Filter Material Depth Filter Material ____l __-------________________________ Distance to nearest: Well _J __ _ Fdundation ----IV________-._z Property Line _____-�------------- - _ _� SEEPAGE PIT [ ] Depth ___________________ Diameter ________________ Number __ Rock Filled Yes ❑ --ffo-117 WaterTable Depth ------------------------------------------------Rock Size ------------------------ ------ Distance to nearest: Well _______Foundation ____________________ Prop. Line ----------- .......... REPAIR/ADDITION(Prev. Sanitation Permit# ------------------t------------------------- Date ------------.---------------------I -f Septic Tank (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 tl at 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 Work Compensation laws of California." ; Signed ---�--- Owner By ----- [[[ llll -------------- Title _ ------------- -------------------------- -------------------- t (If other than owner) FOR DEPARTMENT S ONLY APPLICATION ACCEPTED BY ------ -------------- DATE --- _1_C ------------------ -------- - - - --- BUILDING PERMIT ISSUED ----------------------- ----------------- ---- ----- DATE ADDITIONALCOMMENTS ------ ----------------------- -------- --------------------------------------------------------- ---------------- ---------------------------------------------------------------------------------------------- -----------------------------------------------„--------------------------------------------------------- ----- -- 'r` ---------------------------- ------•- 1-1 /rj - ------ ------------------------------- -___- --- ---- --- - -------------- - Final Inspection by: ------------------------------ l Date : '6='�z SAN JOAQUIN 1.0 K*LTH P))IS R,CT E. H. 9 1-'68 Rev. 5M