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FOR OFFICE USE:f j__ �- ' ` APPLICATION FOR SANITATION PERMIT a (Complete in Triplicate Permit No. . ________________ -----------------------------------------A--------- p ----------------- --------------------- ---------- -------- This Permit Expires 1 Year From Date Issued 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. 549 and existing Mules and Regulations: JOB ADDRESS/LOCATION..--- Owner's -----�� I }_ j� R------------PITON CENSUS TRACT _-S-_SGS-------- Owner's Name --- _�Vk - ,��:---,-r��1�/��j-)------------J�---� --------------�----------- --- ---Phone ------------ -------------- - - --- q ter - - - - Address ,1-�z- }----6�A-6--t- --��1--------------------------- City i ----- Contractor's Name . Rtl - - pC3 ' License ---- ---_ Phone ----------- ------------------ Installation will server Residence partment House CommercaloTailee Court ;❑ Aotef ❑Other ) Number of living units:---I------ Number of bedrooms 3------Garbage Grinder s_ Lot Size ACR-FA_ .�E.--- - ------ Water Supply: Public System and Aame ------------------------------------ ---------Private ®� Character of soil to a depth of 3 feet: Sand'❑ Silt Cl Clay ❑ PeatEj Sand Loam ❑ Clay Loam �. Hardpan'❑p'"Ado'be'❑'='`Fi�l'M�pterial�-. .Q�If (Plot plan, showing size of lot, location of system in relation #o wells, buildings, etc. must be placedeon reverse side.) NEW INSTALLATION: {No septic'tank or see age pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT SEPTIC TANK' =u_ Liquid Depth -------------------------- [ Size =------------- ---------------- - Ca acit t yP o. Compartments P Y e Maternal �------------------ Distance to nearest: ell _-----___---_ __--_- _ _` __Len thof each IineFoundati� n TotahLeno h Line I. #_..__. LEACHING LINE [ ] No. of Lines E--___--- k 9 g 'D' Box ----------- Type filter Material ------------'�------Depth-Filter M tenial ---------- --------- ------• -- ---•- �f1 Distance to nearest: ell ------------------------ Foundation S .. -----.-----_-_ r:__ Property Line .-I----_ _.- SEEPAGE PIT [ ] Depth -_ ___ ameter C P Number------------------ -- Rock Filled Ye [] No I❑ G Water Table Depth - - ----Rock�Size --------- ---------- _ _ Distance tonearest: ! .--___-__ _~ _W.Foundation _4� ,_ Prop. ---•-••-----------•--- REPAIR/ADDITION(Prev. Sanitation Permit# -._ -------'-_ � �-� .). I - --------------- ------- Date ---------------- ----�---------- Septic Tank {Specify Requirements) '---____-----___ .__ ,.---w_.,.. ._�.______ Ier -' - ------------------- --- t D'sposa! Field (Specify Requjrer�nr t . _-_-QI-SS I'30--- 4 01 :, J } g{ J F -------------------------------------- ------ ------- ----------------------- —r- ------------------------------------------------------ - - �-- ------------------------------------------ - F t (Draw existing crud required addition on reverse side)= _ I hereby"certify that_A'Wd-Ve`ptepared 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 si nature certifies the following: "I certify914 in th rformarrce of thew rk for which this permit-is-issued, L hall_not employ any person in such manner f as to b oma "ub' t to r man'sACom nsation laws-of California." r s� Signed --------------------------------------- Owner -- - BY ------ ----=---------------- - .� other than owner) -- t Title ---------------------- (1 ! __ —_,_ �--• - . _.> 4— FOR--DEPARTMENT--LiSE--ONLY--�- --�-- APPLICATION ACCEPTED BY .-__ I-�;''` _ _.`t ,`_:_le. --- . ----- ---`'=--`= ----------- DATE ---- BUILDINGI-�` ` -PERM]7-4SSUED -- --__- =-- --_-DATE=_ -=--_--•-•-_---- _ ADDITIONAL COMMENT --- --- 1---_-__'--- --------------- ---------------"------------------------------------ ------ - -. ---- -- . - -- -- - - Final ins actio �> ---------------------------------- P --------------------------- Final ---------------- ------ -Date SAN JOAQUIN LOCAL..HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M