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FOR Oi-F!CE USF: `PPLICATION FOR SANITATION PER"T Permit No. _-7v (Complete in Triplicate) Date Issued ....... - ------ ---- This Permit Expires 1 Year From 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 Rules and Regulations: �Ju q MTC-19 --CENSUS TRACT - -_5- .-_.---- JOB ADDRESS/LOCATION _ 1�0-�l_��_- �� - -�wy-----/ � - Name '____._. ___ U.�.rup- -- R.iH ; --------------------- Phone - ---------------------- Owner's Address l Q -------- ly / I C Contractor's Name ---P1 1VF—R._e-----------•-------------------------•--- ------------License # _---------------- - Phone .. . - --------------- Installation will serve: Residence ❑Apartment House❑ Commercial ❑Trailer-Gear} [� Motel ❑Other --------•-------------••------------- Number of living units:':_- ___- Number of bedrooms _�L....Garbage Grinder .NO_._. Lot Size -.2Q X 19 _ Water Supply: Public System and name -_-________•____________________________________ ____-_________Private Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat❑ Sandy Loam Er"Clay Loam ❑ Hardpan ❑ Adobe ❑ Fill Material_'_-- If yes,type -._.__.._.._-________-- (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 seepa pit permitted if public sewer is available within 200 feet,) (/ PACKAGE TREATMENT [ ] SEPTIC TANK f Size._'/X V._X___5--_.._-_..___-_ Liquid Depth ---/_--`--_.___-------- Capacity .I;WQ_-_._- Type PWIRB._ Material_CPWRT__ No. Compartments ----2—___---__ Q Distance to nearest: Well , 71,- -----------Foundation --------- Prop. Line ---•------------------ LEACHING LINE No. of Lines ___ —.__ Length of each Total Length ---4 line__.7Q_�_ g Q r � 'D' Box Type Filter Material _RQC_K___Depth Filter Material ----[q.. ............................... t-!- 1Q_�' ___ Property Line _ _1_"1_ Distance to nearest: Well _��___ ._______ Foundation _ _ --..----- SEEPAGE PIT [ ] Depth Diameter ________________ Number Rock Filled Yes ❑ No Water Table Depth ------------------------------------------------Rock Size ------------I------------------ Distance to nearest: Well _____ ----------------------------Foundation - ------ ----------- Prop. Line ........._____.._.--- \ REPAIR/ADDITION(Prev. Sanitation Permit# ------- _ ---------- -------------- Date _ _.___...._-.______________-) r Septic Tank (Specify Requirements) - -- ---------- -- -------- --------------------------- ------- -- ---- ---- - ---- Disposal Field (Specify Requirements) ---------------------------------- ____ _____._._-------- - -- - - - ------ - - ---------- ------------ - - - - -------- ---- -------------- - ----------- - ----------- - ------- - -- -------- -------- ------ - -- - -- - - ------ (Draw --(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 subje t Workm i=;7 ' n laws of California." Signed -- - -•----------- -- Owner By . .. ----------•----------------------- ----------------------------- -------------- -- Title (If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY -_-----FOS••-1g4;---QL,SF ---------------------- -- ---- DATE ..._3.'.C2_-.Z. .-'- BUILDING PERMIT ISSUED ---- -- ---- ----- - DATE .-- ADDITIONAL COMMENTS -------------------------------------- ;�'`= - =_---- -.�i,,------------------ -• -•---------- ........................... -------------•--•-----------------•---------------------------•-------------------------------------•---•------------ ----------------------------------•------------------ ------------------ - •--- �Final Inspection b ___________.Date _. SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M