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FOR OFFICE UISE: `PLICATION FOR SANITATION iP' _ it No. . .................. (Complete in Triplicate) Perm _ .... .. .... ..... ..... ......... 9 .. J This Perr-- +Expires 1 Year From Date Issued Date Issued /._... Application is hereby made to the San JoaqL•in 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/LOCATION ....��T. :'iL_...I fz-pr ., .-�7(_-.../r (>Co(.�_': ...-j.. .'�--.,..._.._ CENSUS TRACT .. Owner's Name ......... ...... .y ... -... . ...�. .liPhone .�. ...'. _ ...._ Address . P� ' c .. iCCity .f..} ---...--- ...---. Contractor's Name --��...X • T�--K'-� - ` ------------ - --License # � --- Pho.n. e _ ,g Installation will serve: Residence ❑ Apartment House-❑ Commercial (XTrailer Court 0 Motel ❑Other --------- --- -- ---------- ------- <) Number of living units: Number of bedrooms ----.----_Garbage Grinder ....-------- Lot Size ............................................ � Water Supply: Public System and name .. ----------------------------------. -- .. ------•-•••_.--....•....---- ------ -------_--- ---.Private Character of soil to a depth of 3 feet: Sand j] Silt ❑ Clay ❑ Peat ❑ Sandy Loam ❑ Clay Loam,®, Hardpan ❑ Adobe ❑ Fill Material -.---------. If yes, type -------------------_-.-.... � - N (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 tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ I SEPTIC TANK j ] Size................................................ Liquid Depth -..- .................. Capacity �-fie 6W Type/_!'�_69. .T Material...01YC -.. No. Compartments ................' Distance to nearest: Well ....................................Foundation ...------__--------- Prop. Line .....................� LEACHING LINE [ ] No. of Lines _....... ... Length of each line . - ------ Total Lengths ............... D' Box ...lam..... Type Filter Material .......Depth Filter Material _. ±n.��.............................5 �= Distance to nearest: Well ........................ Foundation ......... .............. Property Line ----------------.---._ SEEPAGE PIT [ ) Depth _.__._. Diameter ............... Number .-.-... Rock Filled Yes ❑ No WaterTable Depth --- ---------------•-...........---•--••--•-....Rock Size ................ -----•----•---- A- Distance to nearest: Well ........................................Foundation -------------------- Prop. Line --.-------.--.-•----_� REPAIR/ADDITION(Prev. Sanitation Permit # ..... ..f- . .... Date ..�v.`. - ._._.. ) -Se tic Tank (Specify Requirements) ---------------. ------- --------_--3...` 7 DisposalField (Specify Requirements) ----------------------------•------•-------------------------------------------•------------- ------------------------------------- -- -------- ----- ........................................................ ------. ----- . -- •---- .. ........................ ---------------------•---•-------------- ----------------------- ---•---------- ------------ ------ ............................. (Draw existing and required addition on reverse side) I hereby certify that I have prepared 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 signature certifies the following: "I certify that in the performance of the work for which this permit is issued, I shall not employ any person in such manner as to become subject to Workman's Crpensation laws of California." Signed .. .:..oaA-. •� �' ;i' .. .`.'? Owner C / By - `�' "-. . ............- :..... Title _... - . -.. ..........-... owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ----- .--•..........................-.....------ ......................... DATE ....7- -------------- BUILDINGPERMIT ISSUED --•................ ..................... ... .............................................DATE ........... ............................... ADDITIONALCOMMENTS ...... .. ...-•--•...... . . • ...... --•• . -•-••-•.............................................••-•••..............---•-••-•••••....•-_..... ........... -• .......... •.....-•-......_ .. .......................................... �. ........................ .._ tion 1� .Final Inspec .. •-•........ ........... ..• Date SAN JOAQUIN LOCAL HEALTH DISTRICT G u 13 24 1-,/,A o,.,, reg 7/79 3 1.1