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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Isf Permit No. ...7......... .. 7 I3S (Complete in Triplicate) Date Issued ..._.......... ___.._--_---- This Permit Expires 1 Year Frain Datelssued FZ5-_ 3i0 --zr0 F 2rOD i� - t 6"-c W�4 Y. Q� 1 'Application is Hereby made torthe San Joaquin Local Health District for a permit to construct and install the work herein i described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION/101 ..iti?PTRACT:._. ��j�fll .-¢'-- 1 /ll�y�-/1G�-FNSUS .......................... Owner's Name ._,r.� ��' Irl�/s/ �r-_-----------_-----_- .............................. ---Phone ---------------------------.. Address . .� `- QiX �f-/ ►,.tL/3--------------------------------------- City . S.04F� .r/�------- -------------------------------- Contractor's Name /Lipp t.� � � /� .---------.............. . ...License # ....... ..... .......... Phone ............................. Installation will serve: Residence ❑Apartment House f—] Commercialx1railer Court ❑ Motel ❑Other -----. . ............................... _ Number of living units:......... Number of bedrooms ^....Garbage Grinder�/Q- Lot Size �. . .-. ... .. -•---•- Water Supply: Public System and name ............................... ...Privatek Op Character of soil to a depth of 3 feet: Sand ❑ Sift❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam L7 Hardpan ❑ Adobe X Fill Material .............. If yes, type ----___--- -._._-._ p (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 pblic�sewer is available within 200 feet,) PACKAGE TREATMENT [ ) SEPTIC TANK Size. ..... .................. Liquid Depth�_�ff .......... Capacity 1,;?e;Je ..... Type �8. 1�. Material.��3 � ��.. No. Compartments .______-..- Distance to nearest: Well ... . ...............Foundation ;70-/--------- Prop. Line,,/.2.d9.____... LEACHING LINE ➢(( No. of Lines ...../... .. Length of each line..ef-I.............. Total Length A790.V "----.__...__._._ 'D' Box /;/p. Type Filter Material --.Depth Filter Material .. ................................ Distance to nearest: Well /0.07_'-_-_-- Foundation 1�/�.�..----- Property Line �Q�.�-...... SEEPAGE PIT 4CJ Depth -._. Diameter r,3��!f'f.___ Number ...-./�_..........._-.---- Rock Filled Yes, No " r Water Table Depth ..._ r -.... . __.__.__._--------------Rock Size r f Distance to nearest: Well .... ......... .........Foundation _,eoo`1 ...... Prop. Line.... ............... REPAIR/ADDITION(Prev. Sanitation Permit# ........ . ....................4__-__-__-_ Date ---.._._______..______._._________) Septic Tank {Specify Requirements), - . ... --=--••-------------------- ....... ..................... -------------- .......................... ,. , ;. -, . _ _ > Disposal Field .(Specify Requiremenis) .' ------------- ---------•'-�-....._.....---•--------------------....._. ................ -------•----•--_-- ................. ....... ..... .......... ------------------------------------ ----------------------- . ............................ ---------.--------.--------. .... ........... (Draw existing and required addition'on reverse side) I•hereby certify that 1 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 f- as to become subject to Workman's Corripeaaafioe Iciws of-California." „rStgned . Owner BY - ------------ ----- --- � , .-.. .._..-----�-':---------•--------__........_._ Title ��'h�4��C !�?��--•----- . . f other than owner) t FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ..... •. ............. ........•--------•...---_..----........._.._ DATE ..h'�_3. __�_ .... BUILDING PERMIT ISSUED ...................... ._....--............•--•............................:..............DATE ._........................-._.. ADDITIONALCOMMENTS ------------•------- -----------a--------------------------•--------..-. ..........................................................:........................... .... - .....................------------•-----.....---------....._... ........................... .__.._.._.._..--••----------- ....... ......... .............................................. . '� - -..__...... . Final Inspection by: ................... = Date _ -. ...._.__... AQUIN LOCAL HEALTH DISTRICT - F H 9 1-,6A RPV. 5M ' -