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1 F FOR OFFICE USE: f APPLICATION FOR SANITATION PERMIT y p Triplicate) (Carol lata In Trl Permit No. .. ..�.' -4? ... This Permit Expires 1 Year From Date Issued Date 41 L 1 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: ' !JOB ADDRESS/LOCATIONRoacT,•--.__..Trac7................ ............... ..CENSUS TRACT ....................... . iOwner's Name ....................FoG er:.Rehn.... Phone ...7 86.. �......... ....._...-.. ................. .: Address .............................. 9. .................. ......... City . .TxaCY.................................... .............1......... P DIST P�JNIDIri}G SVC. P 8 $6 .. Contractor's Name ..-.._A ... ............"---...-....-..-...-.. ._.......................License# -.995 '#.....--.. hone _.._. 5•` Installation will serve: Re sidenceXX Apartment House❑ Commercial ❑Trailer Court ❑ Motel❑Other ................................_......... t ' Number of living units:-..--.1.. Number of bedrooms ._.- -.....Garbage Grinder -. -. ..... Lot Size ...... g9 ...._... ......... Water Supply: Public System and name ................ .............. .....................................................Private Character of soil to a depth of 3 feet: Sand 0 Si!t❑ Clay ❑ Neat❑ Sandy Loam ❑ Clay Loam W Hardpan❑ Adobe ❑ Fill Material ............If yes,type............................ s r (Plot plan, showing size of lot, location of system in relation ta,wells, buildings, etc. must be placed on reverse{`side.l ,. NEW INSTALLATION: (No septic tank or seepage pit permitted If pvb]ic sewer is available within 200 feet) `. _ Ize- . , Liquid Depth .......PACKAGE TREATMENT SEPTIC TANK .... I. f�• • �H: .,- ; Capacity .................... Type .................... Mater'bl ..._ ............. No. Compartments ..................... Distance to nearest, Well ...............I4..Founclation ...................... Prop. Line . R "LEACHING LINE [ ] No. of Lines .--._._..._. .. Lend+"of each 'fine... ............... ....... Total Length -..._..__......._.... ._.., ......................................Box Type Filter Material . De th Filter Materialae•. Distance to nearest: Idell .. Foundc+tion ._ . Property Line ' S' Diameter " Number .'......... ..... .......... Rock Filled Yes No SEEPAGE PIT [ j Depth i ❑ Water Table Depth .................. :..............:.....:.1 Rock Size ................................ i F Distance to nearest: Well ............. ........................Foundation Prop Line .._.. L:. REPAIR/ADDITION{Prey.Sanitation Permit�# .............._ -._.-. ..... Da 1 16 .......................... ........................... __..........____.....__................. ibo ].in ft. 2 ft i wide Z Disposal Field (Specify Requirements) ..............................................----._...................i D.-..__....__.._._._..._ O , lcment�r� to existing 2G'Q ft. 5'u�. ............. .1_.._._....... .. ... .--_. .-_..... ..............._........................... a vers on �c --_._ . •� ......................_........-.......`....._.___._..-.......----........................'................... _..... ._ 5 (Draw existing and required addition on reverse side) . V,heroby certify that I have prepared this application and that the work will 4done in accordance with San Joaquin County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner or lean- sed agents signature certifies the following- "I this permit is issued I shelf not employ an person In such manner. {x "I certify that in the performance of the work far whichp ! P Y Y cs to became subject to Workman's Compensation laws of Col(fontia." ` signed _P QUTST••PLTDMING SERVIC Ma a,a j > By l` -. . .-. :_ -.... Sitio....._..__r........... jt � (if other than owner) FOR DEPARTMENT ll E,.QNLY r zs APPLICATION ACCEPTED BY............................................... ........ DATE .....«-. :. `......•............... 4 i' BUILDING PERMIT ISSUED ................................................. .. ......(_ ...... ................_DATE .................................:......... ADDITIONAL COMMENTS ........................................................................................... ............................- ......... ,.r. _ - ......................... S, tiY Final inspection by: .... ....................... .. .... ................. ............. .......Data ..�-::.�:.��.'.. . :...-..-.. , SAN JOAQUIN LCCAL HeALTH D TRiCT ¢ 'I E..H. 9 1,'68 Rev. 5M