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FOR OFFICE USE: A�q 1� APPLICATION FOR SANITATION PERMIT - -- ---------- -------------------- - -i 4.-- Permit No:-.10-`--:_- 061 (Complete in Triplicate) `y ' -------------------- ------------------------------------ Date Issued f -- -9_ � -----_----------_-------------------------------------- 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 is made in compliance with County Ordinance No. 549rand existing-Rules-and Regulations: a JOB ADDRESS/LOCATION ------ -.f -------- --------------------------------d- e / L CENSUS TRACT �� Owner's Name f + = -----_ !- _l ". ....------. � --- �^ Phone Address ---- 41 � a__71:-------------------=--------- -------------- ---------------------- City a lE 7--------------- -------------------- Contractor's Name _ Fro-.w- tI - --------------- ------------------------License `./'- `-- Installation will serve: Residence ❑ Apartment House,❑ Commercial ❑Trailer Court r a Motel ❑ Other . ' t'_ C = '� �✓/ J '"^_ a �, r Number of living units:------ Number of bedrooms ----- - ----- Grinder --_----- Lot Size,�joa .7.__L0*----------------•--- Water Supply: Public System and name --------------- ------------------------------------------------•-----------------------------------P ivate�r I Character of soil to a depth of 3 feet: Sand❑ Silt C] Clay E] Peat El Sandy Loam ❑ Clay LoamA 't W Hardpan ❑ Adobe ❑ Fill Material ----- ------ If yes, type __-_-___.__________________ I �s {Plot plan, showing size �of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.} NEW INSTALLATION. (No septic kink or seepage pit permitted if public sewer is available witw,200 feet,) PACKAGE TREATMENT ._SEPTIC TANK -- ---- Liquid Depth X�'_ [ } Size / ' --------------- Capacity _- .9----- Type)Pir;--/0- 4 ' No. Compartments .---�'�'--------=---- flaterial= =fit--- ___ Foundation __��_�__-___-._ Pro Line _ Distance to nearest: Well -.--_ ___ _ -- p. �----•••--------- LEACHING LINE No. of Lines a• ---------------- Length of each lin�e---��-�---------__-- Tota[ Length -",��-.----------_-_--- D' Bax eVO-._ Type Filter Material/ p � --Depth Filter Material � _`f____-_.___--__________________ s v Distance to nearest: Well _ ______________ Foundation ------------------- Property Line _ '_._____._. SEEPAGE PIT [ ) Depth ____________________ Diameter -_-------------- Number ----------------- ---------- Rock Filled Yes ❑ No i❑ WaterTable Depth -------------- ---------------------------------Rock Size -------------------------------- Distance to nearest: Well ________________________________________Foundation ---- --------------- Prop. Line ----------- REPAIR/ADDITION(Prev. Sanitation Permit# --------------- Date _.__:__________________________-_} O . Septic Tank (Specify Requirements}. ------- ----------------------------------------------------- Disposal --------------------------------------------------- I DisposalField (Specify Requirements) -----------7----------------------------- --- ----------------------- I-----------------------------------------------•----------- t -----A--------- ------------------------------------------------------------------------------- (Draw existing and required addition on reverse side) I hereby certify that I have prepared, this application and Lf at thecy 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: vy "I certify that irf the perFormance of the work•for-which-this-permit-is issued, I shall not employ any"person in such manner as to become suliiect to Workman's Compensation laws of California." Signed ---------------14--- ----- ------------------ Owner By ---------------------- -------- - ------------- -- -------------------------- Title --------- '_----------- -------------------- -------------------------- (If oth an owner) 'ya--),MaV,4RTMENT USE ONLY APPL11CATION A&EPTED BY}-- -----. e -------------------------------- -----------------. DATE -----fy.r�_•`' ---------- BUILDING PERMIT ISSUED ------------- - --- - DATE ---------------------------- ------------- BUICIDING COMMENTS ----------- -- ------ -- ------- ---- -- ---------------------------- ------------------------------------ ---------------------------------- -------------------- ----- - ---- ---- --------------------------- ----------------------------------------- ------------------------------------------ ------------------------------•----------------- - ------ -- ----- ----------=----------------------------------------------------------------------------------------- ---------------------------- -----------------------------------------------------------------=------- Final Inspection b ---.Date --- N J AQUIN LOCAP,HEALTH DISTRICT,—. / E. H. 9 1-'b8 Rev.