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FOR OFFICE USE- ------------------ SE" APPLICATION FOR SANITATION PERMIT f / ---- ---------- - --- ----------•-- ----- Permit No. _111��7L_. (Complete in Triplicate) -------------- 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.-Thi,sA application i� "e.,in compliance with County Ordinance No. 549 and existing Rules and Regulations: / JOB ADDRESS/LOCATION, f ---,-�1Rizi-N--- r--- - --------------------- ------CENSUS TRACT - - ----_--- Owner's Name .-------C-7-F-R_ Ip 7 --------�I E�] }1�----------------- -------Phone -----------------•-----•------------ Address -----////� 1------C . J 1 -: RD-------------------------------• City _ ------------------------------------------•-----------•-- Contractor's Name ---- -F.__ }�t�z.l- - ----------------------------------- .License #z�3. Phone Installation will serve: Residence �"r_tm_ o=m=m'"`c ! ®Apartment House�❑;Commera�❑Trailer Court ,❑ d s1-' r Motel ❑Othe -f• '________Y----------- ----------------- -- Number of living units-------- Number of bedrooms 3-------Garbage Grinder A --- Lot Size _AC.R -------- Water Supply: Public System and name --]V!]--------------•- --------- ---------------------------------------=--------------------------Private ®' � Character of soil to a depth of 3 feet: Sand' Silt❑ Clay ❑ . Peat❑ Sandy Loam P--l"Ciay Loam "❑ , . _ �..Hardpan_ [�i JAdobe'❑.=Fill Ma1 U'terigl.. O....If yes, type -- - ------ ---- --- - -- (Plot plan, showing size of lot, location of sy to in relation to wells, buildings, etc, must be placed on reverse side.[ l NEW INSTALLATION: {No septic tank or see��ptr'age pit permitted if public sewer is available within 200 feet,} }�v� PACKAGE TREATMENT [ ] SEPTIC TANK [ Size ___—1a_�______x_-y_ ____ Liquids Depth ____'!_ -------------- � � 2� `ZDc • - Capacity _�-----------------Uy��P8 F6X5-- Material_-� ---_- No. Compartments ,_--------------------- isDistance to nearest: Wellf__ --------- ___Foundation JQ_____________ Prop. Line ---------------------- LEACHING LINE [tK No. of Lines -----!�__-____`----`_„�Length_;of each line.......9_______________ Total Length . : i � zs _ . ----- ------------------ `F ___ -________-_-__ �FD' Box -� Typ' iltr Material 94� i _ Depth Filter Material _______._-_____ -_-_-_-___ Distance ton_erest:r S } SEEPAGE PIT [ ] Depth _____ ___________ iarneter i ': __INumber -.__-___._____._____ _____ Rock Filled Yes ❑ No i❑ Water Table Depth - - --=-�---------------- �` Rock Size ---------------------------- Distance -------------------------- Distance,to nearest: V1611 _________________t :1_- __.--__--_____Foundation __ --------------- Prop. Line _...___ ---------- REPAIR./ADDITION(Prev. Sanitatign�Pbrmit# - -----------------------------=--� -------_ Date .-------.------.-----------------_} Septic Tank (Specify RequireA encs) ----------- - -------------------=-- -------------------------------•--------------------•--------------- ---------------------------- r Disposal Field (Specify Requirements) _______ --Y- -- --- -------- --------------------------------------- - --------------------------------------------- -------- -- -=----------- ----------------i -i/--------------------------- ------------------------------------------------------- - _ (Draw exi 'Ing and re_qu`4a addition_on reverse side) arm I hereby certify that I have pre r�� this ap lication and that theworkwill be done in accordance withh''San Joaquin County Ordinances, State Laws, .and Rules a �d Regulations of the. San Joaquin Local Health District. Home owner or licen- sed agents signature certifies the,fol.lowing: "I certify that in the perFormanc o the work for which this pl rmit is issued, I shall not employ any person in such manner as to beco a subject to Work 's�Gompens tion la of li#ornia." p' Signed - ----------- - ----- I----- } Owner BY {4 ° -- =- -- - '=_ ;! Title ------- - (!f other an o ner ;I " FOR-00Att-�MN USE ONLY APPLICATION ACCEPTED BY T+ -= '- __ _ --------------------------------- DATE ------- ---- --- I�-"` �- -- ----- --- ---- „-„^„— BUILDING PERMIT ISSUED- ----_"7 ? HG _:� `�i � -- •_ '�__�_. ADDITIONAL COMMENTS - -- -g_M-------` ' ` r'_'---- ,,�' __ --�_ _ ---------------- - ------- ----------- - ------- ----. -----------------.-.-.-.---- -----_ _ -- ----------- - - - - - ---------- __---------- -- - - gyp. Fina! Inspion , -- -- -------.Date .. / + •1 '`i t SAN JOAQUIN LOCAL HEALTH DISTRICT t F. H. 9 1-'68 Rev. 5M V