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FOR OFFICE USE: APPLICATION FOR SANITATION PFA-MIT --- ----- --- -------- ------------------------------ Permit No.L�f h. -.. �W (Complete in Triplicate) -� , li 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 i� desc Wcl. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: JO ADDRESS/LOCATION t,- -- _2032----c_--___--_-_I11ALD --......CENS�IS TRACT ----------------•.--.----- Owner's Name ----- --------------------------------------------------------------------------------------Phone ---- . city - �c,-- -------------------------- - --- Address 2��3' - Contractor's Name --_J ... :._ � .. 44 --: sf'p .License # ------_--:-------------- Phone �'r3� ------ Installation will serve: ResidenceApartment House❑ Commercial:❑Trailer Court ❑ Motel ❑Other --- ------ Number of living units:._f-.__-__ Number of bedrooms .___.....Garbage Grinder AP--__ Lot Size ____________ ______ ________________________ Water Supply: Public System and name ---------------------- ----------•----------------------------------------------------------------------------Private` Character of soil to a depth of 3 feet: Sand❑ Silt 1] ClayX Peat❑ Sandy Loam -❑ Clay Loam,E-] Hardpan ❑ Adobe'❑ Fill MaterialAO,--- If yes, type ---------------------------- ;I ' (Plot plan, showing size of lot, location of system in relation to wells, buildings, .etc. must be placed on reverse side.) NEW IN5TALLATION: (No septic tank or seepage pit permitted il public sewer is available within 200 feet,] PACKAGE TREATMENT ( ] SEPTIC TANK�< sSize.-5- � __ g- Liquid Depth --`- -------------------- 0 Type 7 Materiai.�� . No. Compartments _ 2-___:. ... W Capacity yp P �. Foundation -- ------------------- Prop. Line--� UIwE Distance to nearest. Well ___. ------------------------ �� I LEACHING LINE No. of Lines --_._. ----------------- Length of each line--- I---------------- Total Length :__ _ .............. If 'D' Box ------------ Type Filter Material�X--_-_,Depth Filter Material _--f_�--_-_-_-__- .............::... Distance to nearest: Well ------------------------- Foundation ------------------------ Property Line SEEPAGE PIT [ ] Depth -------------------- Diameter ---------------- Number ------------------ --------- Rock Filled Yes.:❑ No :0 Water Table Depth ------------------ -------------------------_-Rock Size ----------------------------•--- Distance to nearest: Well ---------------------------------:-------Foundation -------------------- Prop. Line.,:,:- ..------------ REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date .------------------------------_._] Septic Tank (Specify Requirements) -----�Z _... ---'#'79-1Ji ------------------ - - -•- ----------- Disposal Field (Specify Requirements) -_� ____ '� Cr.___ a� .-_ "g ...... .__ !-_ H19-0— --------- -------------------------------------------------------------- ----------------------------------------------------------------- - ------ ---------------------------------------- ------------------------------------------------°---------------------------------------------------------------------- .------ ------ (Draw existing and required addition on reverse side) I hereby certify that I have prepared this application and that the work will be donein accordance with San Joaquin County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Horne owner or liven- sed agents signature certifies the following: r i such manner I certify that in the performance of the work for which this permit is issued I shall not employ an person n s fi► p p p y y p as to become subject to Workman's Compensation laws of California. Signed-------------------------------------------- --------------------- Owner BY bA g� ---------------- Title ----e�C 3M�MV_-------------------------- - o (If other than owner) •f T FOR DEPAR ' ENT USE ONLY APPLICATION ACCEPTED BY ----- ----------------- DATE ' ------------ BUILDING PERMIT ISSUED ------------------------------------------- ------------------------------ ---------- --->--------------DATE ---� -- ----- - ._..-•-------•- ADDITIONALCOMMENTS ------ --------------- ----------- --- ------------------------------------------•-------------•------------------------------ -----•--------------------- ------ - -- -- ---- --- - - ----------------•---------------- --------------------------------------------- ---------------- - ------ --- - -- ----------------- ------ ----------------- --- -- ------------------------------------------------------------------------------- - ------------------- ------ ---------------- --- - ----- ------ p� Final-Inspects �� - Date ----- -- `�d-- � SAN JOAQUIN LOCAL HEALTH DISTRICT E. H: 9 1-'68 Rev. 5M