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�-Fr�� ..+.,»...,. ,.., •'?�.a,�....,. ., ,..� .-.,,, a.. ".s'E.onw,. ��cw,..—... .. . .. __.- .«m,-.rt4 s""'�°�„fb+z"r„g'.::q�{/�� t. �. FOR OFFICE USE: II� q .� . APPLICATION FOR SANITATION PERMtT. 7 .. ita _.:..... Permit No. .". ....... (Complete in Triplicate) .................... '............-..- try Hate ISSU@d .�..�............. � � ............................... ..�^� This Parrott Expires 1 Y+tar From bats Issued w� :'Application is hereby me lA to the San Joaquin Local Health District for a permit to construct and install the work hereto $�f"r -described. This upplication is made in compliance with County OrdinancA IJa. 549 and existing Rules and Regulations.-.. JOS'ADDRESS/1CCA710N .G. .�....... .... �-. . . .. ...I ........CE US T `rx.'� Owner's,'Name :.. f11. .............. ,• #�.�a,.. •.�..� Phone i Address .......... -�}'""_. .. C ................................. s t Contractora Name .- t}il s_e-�.... . . .. License .?ci--r Phone,-.............................. Installation will serve: Residence partment House❑ Commercial [-]Trailer Court ❑ ; Motel ❑Other........................"................... ; -"g6, . Nu mber of living units:--... .r..- Number of bedrooms -,�--...Garbaga Gr!nder ............ Lot Size ....4�t_ s.. `- I : Public System and name ..-.-..................................... Private x Water"SupptY _....... FSE } # r Character f sail to a depth ol 3 feet: Sara❑ Silt❑ Clay ❑ Peat❑ Sandy Loam L7 Clay Loam (� t Hardpan C] Adobe E] Fill Material ............if yes,type...............:........ pian ,showing 'size of lot, location of sys'arrt in relation to wells, buildings, etc. must be placed on reverse side.): iNS i,1LLAT10Ne (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) ' : PACKAGE TREATMENT JI SEPTIC TANK Liquid Depth .............. x, a Copacity :0- ... Type ' ' Material.. .tAA tNo. Compartments A:_.`..::..... Distance to nearest: Well ........ �.............Foundation .....Ip..!....... Prop, Line ..... ... r ; LEACHING LWE [ No. of Lines .......�...... Length of each line......•1.t�.o............ Total Len th" ..A.C.?? Lw�� D 13ox ..:��...... Type fitter Material .Sr ......Depth Filter Material ..... f. .................... S ! � F Distance tc nearest: Well ......- a'�.-�.--.- Foundation .......�.a..�... Property�Line ... ....... {t a l v SEEPAGE Pit' (� Depth _.�-,�..47.... Diameter -,-..�.. Number ...........LR........... Rock Filed Yes Ie4' Na (- r r .� 7 Water Table Dcpth ...........4' --------------------Rock Size -..- -... ..r3....-- y K i rr �-r Distance to nearest: Well . .............y.�. ..r...........Foundation .......1 ..r... Prop." Linc 4 � e REPAIR/ADDITION(Prev. Sanitation Permit#------....................".........-..".... Date .................................) Septics ... Tdrk (Specify Requirements) ..................._..-......:-.-........-...-..--.... .. Disposal Field (Specify Requirements) ................................................... ............................ ............. .......................................... ...................................."-... ...... ............................................... ............-............ + ..... (Dray existing and required addition on reverse side) i Korebj'iertlfy that 1 have prepareA this application and that the work will be done in accordance with San Joaquin b Ccu"ntyXOrdinances, State Laws, and Rules and Regulations of the Son Joaquin Local Healtl+ District. Home owner or Iicen- :sod agents signature certifies the following: "t certify+hat in the performance of the work for which this permit is issued, t shall not employ,a_ny, person in such manner . i��< �T* as to become subject to World Compensalior laws of California." .,., Signed "......":.......... .. . ......... Owner 1:1 .aJ By............. .. ...................... ,...`„a.. ..... .. �0 Jitle ...... ...... . L...............-................... .., .w,.;, (!f other than owner) y FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY .. .�.. ...... ................._... ............ ............... DATE j"/.'.f.� ..P.-................. x`: '•: i`: BUILDING PERMIT-ISSUED ... ......DATE ................................... ADDITIONAL COMMENTS....... .......... . t :........................ ...... .... .......... ...,.......................................-.................... /1 ..... .. ..... + Final Inspection 5y: .-. .................. ... ................ ._ ..........Date ./.... ... ".l. .'............ r SAN JOAQUIN LOCAL HE/,LTH DISTRICT r E. H. 9 1-'6B Rev. 5M 1 i