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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT R .r ----------------------------- --- _ -9� - {Complete in Triplicate} Permit No: ----------------------- --------------------------------- Date Issued -------- -__- ---_-------_--_ This Permit Expires 1 Year From Date Issued -- .� D9 . Application is"hereby made to the San Joaquin,Local Health District for a per to construct and install the work herein described. This.application is made in compliarice with County Ordinance No. 549 and existing Rules and Regulations: ��f /�/} JOB ADDRE55/LOCATION --_' ----- � ' r 1 ----Phf_1_ CENSUS TRACT ------•----------- Owner's N6meJ ----C) ----QF-----R�1�/I�_Rt3_N_K------------------------------ -- -------Phone -----. t<? / za_ --------------------------- RNFR_MNK------ --------------------------- City Contractor.s.Name:T� -~-� •_ Dl ��= ---` "�-'�'G --- --license � _ __�7�_-Phone-.�3_7_ g-�Z-- ---- ,.�iLtttC.E /e rL�0 — 4 )(ll�(C� % 31�fi1 ��E.�(� lnstalfation�w-ill serve:. . _Residence ❑Apartment-House E3-.9q a- ercial ❑Trailerourt :❑ _._, _ __ - Mo iA.I ❑Other _CI.7 ------------ Numb ----------- I Number of,living units:____^-___ Number of bedrooms; ✓-��Garbcge Grinder -.--___. Lot'•Size ____ C�-E --_______-_.- Water�Supply: Public System and name_C1_T�'_-61F,_ IV ER_3l-9&}��- --------•------ --------`-= -------------------Private ❑ Character ofisoil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat❑ Sandy Loam Clay Loam ❑ � t i Hardpan ❑ Adobe ❑ Fill Material __ " _la___ If yes, type _:_____-_-_ -- �• .'J� ` (Plot plan,`showing size of lot, location of system in relation, to wells, buildings, etc. must be placed on reverse side.) '� i I I i I ,,'_ I-)NEW INSTALLATION: \(No sbptic tank or seepage pit permitted if public sewer is available within 200 feet,) ; PACKAGE TREATMENT . ] SEPTIC TANKSize___ 6- -X1_ -='Liquid Depth i p �yI,'---,-,f. f�4 _4 'Type'_12P 131E-F04%terial----COAJC—- No. Compartments - Ca acct �--� ------ ----------------Foundation - -------- ------ Prop., ----------•------=---- Distance o nearest: Well C�{l ,t!�___ Line --- ---:______-_ LEACHING LINE No. of Lines --_.J/_______________Length of each line_______ ------------ Total Length,-IM�-_ --__________.- w D'i13ox)TF�3_`Ty pie Filter Material _RSC!{_"Depth Filter Material _______1 _]_____._1_____________________ Distance to nearest.)Well _---- _!: =---- Foundation -------- Property Lie GC-?IT [ ] Depth, . ,____a_<��r_ Diameter ________________ Number ----___-______-_------------ Rock Filled 'Yes ❑ No 0 Water Table Deptii ----)-7----- ------------------- =--------Rock Size -------------------------------- 1 i i •' a- Distance to nearest-, Well ----------------------------------------Foundation -------------------- Prop. Line ...____-_____________ Permit# ---i----------------- '-------"--- ----- REPAIRfADD1TION(Prev. Sanitation Date :=_----------------------__-- Septic Tank(Specify Requirements) ---------------� --------------------------=r {- 9------------------------:----- --------- ,, Disposal Field (Specify Requirements) ' ---- `------------------------------------------------------------------------------------------------------- --------------- ----------------------------------------------- - -------------------------------------------- --------------------------- ------------------------------------------------------------------- {Draw JxWing 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, giid;.�tules�anid Regulations of the San Joaquin Lo 't 1 Health District. Home owner or licen- sed agents signature certifies the fdlowingr [ I "I certify that in the performance of the`work for which this permit is issued;I-shall.lnot employ any person in such manner as to becom su t to Wo km -ompensatia la of California." i i - ;' { Owner - Signe ----- - Pi �i �_ � 9 ---------------------------------------"---'----_---------------------------_-- Title - = (if other than owner) _ FOR DEPARTMENT USE ONLY APPLICATION ,'ACCEPTED BY ------71R--a--=------------------------------------------------------------------------- .. DATE -----I f7: ---------------" BUILDING :PERMIT ISSUED - --------------------------------------- - ---------------------------------------___----------DATE ------------------------------------------- ADDITIONAL)COMMENTS ------- - ----- --------------------------------------------- ---------------------- -------------------------- ------- ----- --------------------- ------ ----- -- --------------- ------------- -------- �------------- ------- - ------------------- -- --------- ----------- ---- ----------------- ---------- -"--------- ------------------- - ---------------- --- ------ --- -- -- --------'----------------------------------- ff / Final In'specti } ----------------------------------------.Date ------ X11_` 7--0------------- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'b8 Rev. 5M