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tl ' FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT t< --'- - ------- ----------- - ------------- ----- Permit No: -'---- .-'�-�-"--�=-�---- (Complete in Triplicate) ----- ----------=- - 13 Date Issued - ----------------- ---------------------L-------------------:-------------- 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 Js made in compliance with County Ordinance No. 549 and existing Rules and Regulations: , ik JOB ADDRESS/LOCATION ---/2-'02-------� 20- ---------R' I��-� ------�1�------ -'� ------CENSUS TRACT ------ S�_--__ Owner's Name MRS -----4.l�Q �E Ri ----- ELS_P-EP-11- --------------------- - -----Phone'------------------------------•--•-- j7 p� , Address _ 207-02'--_--- � --------- � 7�_��:� �D-------------- Cit �_F A ------- Y Fi i Contractor's License # Phone Installation will,serve: fr Residence E�'Apartrnerit--House❑ Commercial :❑Trailer Court ;❑�.-�'"'�- � . y Motel [-1Other. ----------------------- ` t !7 .----------- Number of livin1 g units __._ Number"`'of bedrooms ______Garbage'Grindery - L�t.Size Water Supply:u'bl c-5ystem and name—'=- ---- -- --}-- � ---------- -------------- ----- ------ --- --- -----;- Private r[}_ E... Character of soil#o a depth of 3 feet: Ha d d❑ A�0 Clay I❑ Peat Sandy Loam `Clay f oam=❑`--` Silt f p ❑ be ❑ %F-ill Material ` yes, type - 4 (Plot plan, showing size of lot, location of system in relatioIfo wells, buildings, etc, must be placed on '17 erse side.) I NEW INSTALLATION: {No septic tank or seepage it perrriitted if public sewer is availabl within 200 feet,]- i - } Liquid, ----- PACKAGE TREATMENT [ SEPTIC TANK'[ j Siz6------=--------- `------- -:----- q p 0 Capacity ------------ --- Type ------ Material = I N . Compartments .-:---:-----� Distance-to nearest: Well _L------------------- ____________Foundation f--__.___ .----------- Prop. Line LEACHING LINE [ ] No. of Lines _______________________ `Length:zof�each�lines°-'---y-Vii________-_.___._ Tota! Length ` 'D'� Box ----- ------ Type Filter Material _______________=___Depth Filter Ma rias _ -------------------- ----------------- --------------- Distance to nearest: Well ___ _!________________. Foundation __________________- _-- Property. Line __,____ .._.______.._ SEEPAGE PIT [ ] Depth --------------------- Diamet c ________________ Number _.t._.__.__--- I__.__ Rock Filled Yes No i❑ < Water Table Depth ---------- --------------------------------Rock Size --- ii : Distance to nearest: Well -- -- 1.- --'------------- ------ ouridot;iiyrr --- -------- Prop. Line -..•• --------- ....... REPAIR/ADDITION(Prev. Sanitation Permit# --------- _ ____ ---------- Date ________________ _ _ __ Septic Tank (Specify�Requirements) --------- ---------------=-------------------------------------e- ............. --- --------------•-----"--•<---------.---------------- Disposal Field (Specify 'Requirements) ic_ 1 r l _ .-'"- -------'RC----------- ---- -------------------------------- �F __ 4 F ------- --- --------- /_---- - ----- -- '�✓ '� - (Draw existing and required addition on reverse side] 1 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 land Regulations of the San Joaquin Local Health District. Home owner or licen- t sed agents signature certifies the fo)lowing: ertify in the performa e e.wor for which this permit is issued, I shalt not employ any person in such manner t beco subject fo Wor ampen anon laws of California." ' 9 ed - - ._:----- -- -- - ------- Owner i r ` Title - --------- - Vf other than,owner FOR DEPA4TMVQT USE ONLY, "" -� APPLICATION ACCEPTE BY ---- ---------- ___ _ DATE '-- BUILDING PERMIT ISS ED ------------------ ---- ------- --------- --- --- -- -- ----------- - -------- -------------DATE -------------------------------------- _ADDITIONAL,COMM TS--i ' _- - : - ------ --------- ,.e ____ _ .. -----------_ _-------- _ ___..____._ ______ ___________ _____ ____ _ ------------ ------------- "^ tib. 4 Fina;) Inspection bY: m -------- Date -' ___ __ ___ -___ _____ _____________ -_ __�__ i SAN JOAQUIN LQ A -HEALTH DISTRICT i - ,� ,m 5M E:H. 9 1 '68 Rev; ..