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FOR OFFN`E USE: APPLICATION FOR SANITATION PERMIT ...................:!.......:.............:..... P Triplicate) Permit No. ...... 6 r (Complete in Tr{ licate 7 ...................................... .... This Permit Expires 1 Year From Date issued Date Issued :�. ..'�.5. Application Is hereby made to the San Joaquin local Health District for a permit to construct and install the work herein 1 described. This application Is made In compliance with County Ordinance No. 5A9 and existing Rules and Regulations, JOB ADDRESS/LOCATIONQ/(-!-0.YS qq ENSUS, TRACT .._...................... J Owner's Name ......0 llfop.d............................... .................:.....................Phare ..9,f.7.-.35Y4........ Address .. ............................... City ---tf.nde I7............ ............. ................. 1 Contractor's Name b.IN.J7.P„t"------...........--_--------- - --------------•-- -• ..._....License # .-.-..............------. Phone .............................. II installation will serve: Residence N Apartment House❑ Commercial []Trailer Court 0 i Motel (r]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 0 Silt❑ Clay ❑ Peat❑ Sandy Loam e 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.) i NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT ( } SEPTIC TANK 1' ) Size.... G.�_ _../.Jf...................... Liquid Depth ........ Capacity/(oQ0 ---------I.._ Type MaterialcD.CIG'lf .- Na. Compartments ._.. ..,.._. i 5a Distance to nearest: Well .... .- .1iQ.0.�� _ _ .._ '.. .__..._ Foundation . /Q__.__s._.... Prop. line .�/IBdP/e.�z �� rC,_�Cr LEACHING LiNE [ ) No. of Lines . .__....�--------- Length of each line.'?,O..... L7."_,lQQ Total Length .-.27.,Q....-........... r 1' 'D' Box ...%...... Type Filter Material t#n,2 -AQ9vkDepth Filter Material ..../..9........... .. .. 1_•...... { i ji�°di Distance to nearest: Well ....J,S'e?.......... Foundation ------/0. .... Property Lino ...,�00fxt .--tc.5� SEEPAGE PIT ( ) Depth Diameter ................ Number ..... ...................... Rock Filled Yes ❑ No ❑� Water Table Depth ................................................Rock Size ........ ..................... p Distance to nearest: Well ........................................Foundation .......... ......... Prop. Line ........._..........p REPAIR/ADDITION(Prev. Sanitation Permit# ............................................. Date :...............I............. . SepticTank (Specify Requirements) ... ................ ................ ................................................................ ---.._.................. 1 Disposal Field (Specify Requirements) .......•-----•-:-----•--............................I................. ......................................... ! .............................................. .........•-•.....................................................................I............... , .................................................... ............................ ....... ------•--- ._.... .. .. ..._....-•-••-......._................----- --......................•-• ............ (Draw existing and required addition on reverse side) 1 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, 1 shall not employ any person In such manner l as to become subject to•Workman's Compo ratio ws alifornio.” ' Signed:6 �11 Gi<�Y..... Owner ByB ..........................�..........•---...._.................. Title _....._ . ._ _..... .. ............................_. ........... ....... , (If other than owner) FO DEPARTMEN USE ONLY -. APPLICATION ACCEPTED BY C'r^�......... DATE ............ i BUILDING PERMIT ISSUED ..................................- _ . :...DATE ADDITIONAL COMMENTS ..................................... i ............................. ............................................_.............. ... --- .. ....._._............... . ..............................................................._.............................. .....................I——............. ... ... . ... ......... .... ........ ...................................... .......... l FinalInspection by: ............. .......... ................................................. .. .__:s.....................................Date 1 EH 13 2h 1-68 Rev. 5M SAN JOAQUiN t AL HEALTH DISTRICT 8f7la 3M` - — 4