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9 I� FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT permit No: . .......... ..........................................I�.. (Complete in Triplicate) 3 ................I.--•..........i.. 7 Date issued ......� .5:.... 'M This Permit Expires t Year From Date Issued ' Application is hereby rnadelf to the San Joaquin Local Health District for a permit to construct and install the work herein described. This application i,s made in compliance with County Ordinance No. 549 and existing Rules and Regulations: i JOB ADDRESS/LOCATION .��........_._.1 ...... ..J1`3.�.�1_i .. .. CENSUS TRACT .............:. Owner's Name �o.m.f.,5o'A�.............................. ..............Phone Address ......... .... ...... .` __..........._. City ...._51ac ... -------- d.! _........._.............. ._._.......... Contractor's Name r. R IS-!z_.f'... ..License # ,,ray..: Phone . ��-----• . ;.. a7 ` installation will serve:-"- ResidenceV Apartment House❑ Commercial ❑Trailer Court ❑ v Motel ❑Other ................ ....................... Number of living units:..... Numberof bedrooms.. ........Garbage Grinder ............ Lot Size I-��. _ .x---�� 3-•--•--•••-•- ....._...Pr'ivpe ❑ Water Supply: Public System and name •......:.............. ................ •..-••-•-•--•---•----•---•---•--.........-•------........ Character of soil to a depth lof 3 feet: Sand 0 Silt El Cloy ❑ Peat C] Sandy Loam {] Cloy loam ❑ Hardpan p ❑ Adobe Fill Material ............ If Yes,type ............................ (Plot pian, showing size of 11 location of..system in relation to wells, buildings, etc. must be placed on reverse side.) o% i NEW INSTALLATION: (No,septic tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT I I SEPTIC TANK t ] Size....... ... Liquid Depth C Cdpaeity _.._.....--•-----•- TYPE .. ............ ..." Material....................... No. Compartments •••-- . .€. . i Distance to nearest: Well Foundation ------------------•--- Prop. Line _ LEACHING LINE ;,) No.,of Lines ....... Length of each line..................:......... Total Length .._.......... ........... ` •D' Box . --------- Type Filter Material .......Depth Filter Material ..........•-...._•..........I............... I ,---Property' Line . Distance to nearest: Well ........................ Foundation--:.::..,:. SEEPAGE PIT ( ] Depth .................... Diameter ................ Number .................'.......... Rock Filled Yes ❑ No ❑ Water,.-Table-Depth__...... .....................•----..............Rock Size ------•-•--------...........---- 1r}ti -.Foundation Prop. tine Distance to nearest: Wein-------------•--•--- -------........... .......-----:...._:. ---••--•---•--•......_ REPAIR/ADDITION(Prev. Sanitation Permit ti# ..........r...... Date ............:....:..... = •£,a-•} I ,• Septic Tank (Specify Requirements) ..--•- -----•••--------•.................>...._.......---.:_....._........� -....... - ,,- jj �-" ►, X I Disposal Field {Specify kRequirehients) .._..6Q.. . kt�:C-�.--�^1-�'•� �: � �� ....•�l�!�/fv P� ...... ak —— -----------`----------------------------------•--- •--- ........................ ....................•..:...-•----.---._..... ..._......__._......-- I ............ I�'.:. . ...........:. .....................:._ _.-•-••-•-••--•----------•--....--------- •••---......_.._....-•----. (Draw existing and required addition on reverse side) I hereby certify that I ha le prepared this application and that"the work will be 'done.yin accordance with San Joaquin County Ordinances, State Laws, and Rules and Regulations of the San 4acquin Local Health'dlstrict. dome owner or licen- sed agents signature certifies tlse following- "I F "I certify that in the perforMancerof the work for which--Ihis permit is issued, I shall not employ any person in such manner, as to become subject to Workman's Compensation laws of California.' Signed ...................... � � -------•- ............... Own r Titley , �•3 'h FBy ....................... ---......... . . {if other than o r) t I� foyMARTMENT USE ONLY . APPLICATION ACCEPTED BY .................... DATE ... ...... ... DATE . BUILDING PERMIT ISSUED .............`:.._-- ADDITIONAL COMMENTS'-••..........:... __ ......... ...................... ......................... ...............i .. ....................... _.� ... ....... . '�- .... I f �. t ....... ..........Date ..- Final inspection by: .._.._.. i..... ........ .: .. -:..::...._ ..... . .. . - - - _ t SAN,JOAQUIN_LOCAL HE LTH DISTRICT F w 13 24 I.,bs Rev- 5M 7172 3 M