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FOR OFFI SE: APPLICATION FOR SANITATION PERMIT / ----------------------- (Complete in Triplicate) Permit No. . ---------=----------------------------------------- ----------------------------------------------------- This Permit Expires 1 Year From Date Issued Date Issued ------ Application ___"Application is hereby made to the San Toaquin 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 .__f_l_4141.____.6V --------� ------CENSUS TRACT -------------------------- = ------- - ------'p--� -----Phone Z95 Owner's Name �� -V4.6- - ------ ---- -- ---- - - - Address ...6--'F f------------ APO ia_�!_`TS-------------------------------------- City ----------------------------------------- Contractor's Name ... --------- ------------------------License #1- 7: _3_. Phone _ i 2 Installation will serve: Residence [ -Apartment House❑ Commercial ❑Trailer Court i❑ Mote! ❑Other -------------------------------------------- Number of living units:--- ...... Number of bedrooms .A---..Garbage Grinder 1V_U__ Lot Size __�'�.._h'C! ' � ' Water Supply: Public System and name --------------------------------------------------------------------------------------------------------------Private IFA Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat❑ Sandy Loam -[.jg-- Clay Loam ❑ Hardpan ❑ Adobe-,E] Fill Material ------------ If yes, type ----------------------------- 091 (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) s,4 NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ I SEPTIC TANK' _/ 72 _ Liquid Depth -4/-/----------------- Size--- --'t'f----=�S---1-------------- ---- �1 Capacity _A;2_00--- -- Type 1_1�l�Z Z_ Material�N � Io. Compartments o5----------------- Distance to nearest: Well ---X7V------------------------Foundation -_1---_-_---_---_ Prop. Line __ -----____---_ LEACHING LINE [e4--- No. of Lines _._,527---------------- Length of each line----- ___e--- -------- Total Length .-- _ ......... , 'D' Box Y .- Type Filter.Material (-/<_-,Depth Filter Material ___f ........................ Distance to nearest: Well ____S_P------------- Foundation --f 4------..---.---_ Property Line _--f—---------------- SEEPAGE PIT Depth -------------------- Diameter ---------------- Number ---------------------------- Rock Filled Yes ❑ No 0 Water Table Depth ------------------------------------------------Rock Size -------------------------------- Distance to nearest: Well ---------------------------•--------_---Foundation -------------------- Prop. Line ---------------------- REPAIRJADDITION(Prev. Sanitation Permit# ____________________________________________ Date ----------------------------------) SepticTank (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 that in the performance of the work For which this permit is issued, I shall not employ any person in such manner as to beco e s bject to Workman's Compensation laws of California." Signe --------- ------------------------------------------------------- Owner By --------- --------------------------------------- _ Title -------- ------------ - --------------- -------------------------- (If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED B __ - l " --------------------------------------------------. DATE ----- y . ------------ BUILDING PERMIT ISSUED __.Z/_ ------- -------DATE -------------- ----------------------------- -- ---------------------------- ADDITIONALCOMMENTS ---------- ------- ------------------------------------------------------------------------------------------------------------------------------------------- ------- -------------- - -- ------------------- �� Z_.7 '----{--_lQ_'__c v L �'��c 1` I�'' ate- �l ------------------------------- -------------------------- --- -- --------------------- -------- -------------- ----------------- Inspect b 1 -Rd -------CIS_ ----SS G{e�_�2�/___� I��Y__../C' C... r5_< Oate _ . _ /j�L_Q`_ _\ p Y= �- --- - - ,--- ---------- SAN JOAQUIN LOCAL HEALTH DISTRICT �� scd� CTed ,c. Aad y.Lar-c - eouner ccjFla Slz 1-d X. rlaerd hdd- J00/_ t-� E. H. 9 1-'6$ Rev. 5M Qc'di4�eo -? Ae` -e4or' fA�e -,500y-h /e^n --fit 14 and Atd G'or e � �P4-