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FOR OFFICE USE: ---- -------^---------------------- APPLICATION FOR SANITATION PERMIT Permit No: ----- (Complete in Triplicate) --. '----------------------------------------- Dote Issued -'�a'-�'--�1 --------------------------------------------------- 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: CENSUS TRACT ---------------------------- C JOB ADDRESS/LOCATION --ori-��Gr-aw.e_:_$��•--1-mi,le�--�kest--off`------------- � Owner's Name ------------------- Thorritcsn�--- SS -font iS'-----Le-atar..Bilua,_-----------------Phone 194_r262Q---------_--_ -- -------------------- Address - P--C---Box--Z8-1-,--------------------•---------------------- -------------------- --- City -210-r f lzi€t;.. "a6f36 I Contractor's Name -s--- ------.License # .x.8.1-78.4-------- Phone l-916-m4'S3,-$$71. Installation will serve: Residence ®Apartment House❑ Commercial :[]Trailer Court I Motel ❑Other -------------------------------------------- Number ------------------------------------------Number of living units:-_-----1__ Number of bedrooms Z----Garbage Grinder --------- -- Lot Size ----5t_.SG -P—S----_..------------- j "- Water Supply: Public System and name ---------------------------------- -------------------------------------------------------------- ------Private Character of soil to a�de th of 3 feet: Sdi d'y Siff CIa` ' Peat ISancl Loam 1*--Cla FLoam P ❑ ❑R � Y ❑ — ❑ Y ❑ Y ❑ 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 tseepage-pit•,permitted if public sewer is available within 204 feet,) ) PACKAGE TREATMENT [ ] SEPTIC TANK'[ ] # Size-1200---9allon----------_------ Liquid Depth --_R---- ----------- Capacity --120-Oga.l Type conere-te Material-CLO-nar--eke .No. Compartments 9------................ ' � i Distance to nearest: Well _5Q ----- ----------------------Foundation ------._-------------- Prop. Line---------:__.-------- . .` , LEACHING LINE [ ] No. of Lines _ - g g _. ,_._______ Length of -line._.._�i__�---- Total Length tea- _-.LF_-SQL.__ 'D' Box ------------ Typ Filter Material i,L -4'k-Depth Filter Material _5"-y Distance to nearest: Well _...50�_._. ______ Foundation ----------- ------------ Property Line. _--_--_-._-.__ SEEPAGE PIT [ ] Depth -------------------- Diameter -_��>Number ---------------------------- Rock Filled Yes ❑ No i❑ r Water Table Depth ------------------------------r---------•--------Rock Size -------------------------------- Distance to nearest: Well ----------------------------------------Foundation -------------------- Prop. Line ----_--._____--_.._ .- REPAIRfADDITION(Prev. Sanitation Permit# -------------------------------------------- Date ----------------------------------} Septic Tank (Specify Requirements) ------------------------------------------------------- i--- - ---- ------ -----------------.------ ----------------------- Disposal Field (Specify Requirements) ---__ _ -- -- -------------- CC Cg GG C _ = = -------------- e v ,Q: - , r L -------- - ----------------- --------------- --- -------------- ---------- --------------------------- ----- -- :---- ---- - .� (Draw existing and required addition on reverse side) _ I hereby,certify that 1 have rvp prepared this application and th ai the work will{be done-iin accordance with Sand 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 Compensation laws of California." Signed -vies -------=-------------- Owner --------------------------- Title -----Fre'21!- e,Clt---------------- ------------ (If of er an o -FOR.DEPAitTMENT USE ONLY APPLICATION ACCEPTED B ��- ---- ------ ------------ ----------------------------------------------- DATE �"` ` --------- BUILDINGPERMIT ISSUED ------------------------- ------------------------------------=--------------DATE -------------•----------------------------- ADDITIONALCOMMENTS ----------------------------------------------------------------------------------- -------------------------------- ----------------------------------------- -------------------------------------------------W ---------------------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------- -- - - -- - --- - -- - ----------------------- - - ------ ---------------------- - ------------------------------------------------------------------------------------------ ------------- - -----..------ Final Inspection by - ---- - -- -Date ---- - -----=�-�`--7 --- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M.