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FOR OFFICE USE: M APPLICATION FOR SANITATION PERMIT ---------------------------------------_- ---- Permit No - . (Complete in Triplicate) ' -----------------------------------------------------11_ ___IThis Permit Expires 1 Year From Date Issued Date issued 4_4_Y1_6- 7 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: P JOB ADDRESS/LOCATION:I1_[3E 6a-----?_-----p Q of_v o �------------- S ---------CENSUS TRACT ------6--------------- - -- ---RA,- � �f �----------------------------------�----.-- ' Owner's Name �� ----- --- --'--------- '------Phone -- ------------------------------ Address _�!lLL 'G' r _ ` /1 R6J�L -----_-------- - Cit �h�1-0-�1�------------------------------------•------ y Contractor's Name ---(9. le ------------------------------------------- �--_-License'# ------------- Phone --------------------••-------- Installation will serve: 4 Residence ❑Apartment House-E] Commercial :❑Tra ler Court F1 d Mofe1-[�0ther� 1 _Ri¢}R+ RSTR©c�M Number of living units:_- ;Number of_bedrooms —------Garbagek'Grihd'�r .__-":_ Lot Size ______ CI II- -_______ a-- °s '. Water Supply: Public Syste and name __________________________________ _i ___ Private Character-of soil-to a depdof-31,feet:,° Sand'2— Silt❑,Clay_-❑ Peat[] Sandy Loarrt 0 Clay Loam Ha ----------------------------- (Plot h k Adobe �. rdpan f ❑ Fill Material'-� --- If?Yes, type ---- -- -=--- -- -- --- (Plot plan, showing size of lot, notation of system- `1n relation to wells, buildings, etc. miust be placed on reverse side.) NEW INSTALLATION: (No` septic tank or-se p'e pit permitted i public sewer is a�vailabie within 200 feef,} PACKAGE TREATMENT } ]0 SEPTIC TANK for Size____ _____{___ Liquid Depth _�/ i © � . Capacity :: ____.__-_____ Tripe _R. _FSB_ Mat�eria�, 4/ �__ No. Compartments ____�-_........:.... Distance to nearest: Well --------'-0---f------ -----Foundation ------ Prop. Line of Lines --------,�----_-------- Length of each line _.___- --'------- Total Length ____-J ._......_....-- LEACHING LINE - A16 T e Filter Material n-� __De th Filter D�I Box YP rip Material -- -l_ �{ .:...- Distance to nearest: Well _ __.__________ Foundation _-f± ___ ____ ___ Property Line SEEPAGE PIT [ ] Depth -------------------- Diameter ---------------- Number ----------- Rock Filled Yes ❑ No i❑ Water Table Depth Roc ` � k Size--}---`=---=-------------------- Disltance to nearest: Well ________________________________________Fou _ ------- -------------------------------------- -ndation `------------ Prop. Line --------- ------------ REPAIR/ADDITION(Prev, Sanitation Permit# -------------------------------------------- Date, e _____-- l__ �_____________) i Septic Tank (Specify Requirements) _ ___________ _______ -V___ io =- Disposal Field (Specify Requirements) ------------- --------------------------------------''' - l ---------------------------------- ------ ---------=--------------- -- -- -------------------- --------------------_----------------------------------------------------- - -- ------- P r s � .._+-T r.. ....aj._ +.."+—��. I+ —(Draw existing and�eq`uI ed-addI iori on ,eve�se siae]w I hereby certify that I have prepared this application and that the work' will be dome -irt-�accordance with San Joaquin County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local/Health District. Dome owner or licen- sed agents signature certifies the following: I ^_¢ "I certify that in the rformiance of the work for which this permit is issued, -I shall not employ any person in such manner as to bec a jec o Wohrkman's Compensation laws of California." j i 11 Signed _q '°t - ---------- Owner.,, _____________________________________________ i .. By -------------------------- ----------1,--------------------------- la Title - --------------------------------------------- (If other than'`lowner) j FOR DEPARTMENT USE ONLT APPLICATION ACCEPTED �Y - 1 1r--'- ------------- ---------- -- 1 4 ________. DATE Y BUILDING PERMIT ISSUED 0---------------- --------------------------------f -`-DATE ------------------------- - ------ ADDITIONAL COMMENTS -'I .-- --- -------- ---- ------ --------------- ------ I------ = - ----- --- - --- ------------------------------ ------------•-------------------- --- ----- ----- - --------------------- ----- --------- --------------------------------------------------- -------------- --------------------------------------------------- -- --- -- --- -- -- - ---------- -- -- -- -- -- - -- -- - ' r =i1 6Final Inspec' -------------------------- Date --- .._...., 1. ---...--r-,_—'AN._J.OAQ.UIN,.LOCAL_-L[EALT,,,DJSTR'CT-.-r _.... __.___,,y_- - — E, H. 9 1-'b8 Rev. 5:.