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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ------------------------------ --------------------- ---- � (Complete in Triplicate) Permit No. --------------------- ------------------------------------ ----------------------------------------------------____ This Permit Expires 1 Year From Date Issued bate Issued Application is hereby made to the S Joaquin Local Health District for a permit to construct and install the work herein described. This application is madle i compliance it County O din n e No. 549 and existing Rules and Regulations: f d JOB ADDRESS/LOCATION _Q1 __, 1 te_ d----oad�---_--.°f__Co11i er-. aad------CENSUS TRACT .S ------------------ Owner's Name ----- iii S ai yrs --------- -------Phone.J=2 _-4'73-�19 15 �4C - ou1aRo. a Sockcon--- ------ Address City _ _ qcl �Unr Cal formic Contractor's Name Sanitatior-, Inc. License#x8176--------- Phone 483-84.77. Installation will serve: Residence [Apartment House❑ Commercial ❑Trailer Court- ❑ — Motel 0 Other -------------------------------------------- Number of living units:------- Number of bedrooms ---3-___.__Garbage Grinder ___________ Lot Size ____._3s3-Q.___.X--- -60 t-.________ Water Supply: Public System and name ----k'_a_ter---ae-11---------------------------------------------_----------------------------------Private-K] Character of soil to a depth of 3 feet: Sand❑ Silt❑" Clay El Peat El _Sandy Loam ❑ Clay Loam E] ' Hardpan ❑ Adobe F-1 Fill aterial If yes`, type ____ __ (Plot plan, showing size of lot, location of system in relation toells, buildings, etc. must be placed on reverse side.) NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ I SEPTI CTANK f',] Siz ____!Z5-O0---&a-1�t___-_____..__ Liquid Depth __________________________ Ca aci X00 a1._--p } a - - -- ------- ----------- No. Compartments --- Type Material Distance to nearest: Weil ----------- -------------Foundation ----------------------.Prop. Line ---------- LEACHING LINE [ J No. of Lines __2------------------- Length of each" line,___'100�___- ------ Total Length 200-!----------------- , _ � :. - 'D' Box ._ �______ Type Filter Material -Fl�avel-__ Depth Filter Material _______________-__-._-______---____-.____._ Distance to nearest:.Well -5 ______________ Foundation ------------------------ Property Line ________.,______.,...... SEEPAGE PIT [ ] Depth __. �5_°U Diameter -----;W"' Number _ __2______ ___Y _____, Rock Filled Yes ® No i0 i 1 F .-Water Table Depth.------------------------------------------------Rock Size -------------------------------- Distance to nearest: Well ---1-00-t----------------------�.....Foundation -------------------- Prop. Line -----------.---------- REPAIR/ADDITION(Prev. Sanitation Permit# -----------------------------------------.. Date ----------------------------------1 1 ' Septic Tank (Specify Requirements) - - < --------------------------------------------------------------- -----------------------------—--------------------------- Disposal Field (Specify Requirements) --:-------__ ---------------------------------------------------------- --------------------------------------------------------------- ---------------------- ------------- ---- -------------------------------- ------ --------------------------------------------------- ------------------- ----------------- "'" "'r"`"" ";brow existin and re ui"red 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: ] eA "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 become subject to Work n's Compensation laws of California." Signed .___=- .-` n S -nit 2t� IrsC Owner . - ------- ---- - ---r ------- ' Pre� ic.ent BY ------- - _ ---------------------- Title ------------------------------------------------------------------------ (if o er�h sw e ++ t -DEPARTMENT USE ONLY APPLICATION ACCEPTED BY --- - - -- ----------------- ---------------------------------------- DATE '--- ------------- ADDITIONAL COMMENTS ----- - -} ------1 --BUILDING PERMIT ISSUED-------------I---- .rr"-_ - ---------------- --- ------------ --------------------------- DATE------------------------ '------------- -------------------------------- -- --- ------------------- ---------------------------------------------------------------------------------- ------- ------------ --- - ------------------------------- --------------------- --------- - - ---- y FinalInspection by: ----- ---- -- ---------- ----------------------------------------------------------- --------------- =--------Date - --- ----------------- SAN JOAQUIN LOCAL HEALTH DISTRICT �t E. H. 9 1-'b8 Rev. 5M.