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r FOR OFFICE USE: 3 <� L/ APPLICATION FOR SANITATION PERMIT (Consplste In Triplicate) Permit .............. This Permit Expires�klyear From Date Issued 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: S�vJ` CSR...-- . �� , . v�5 r..3aors� JOB ADDRESS/.LOCATION .:. ....._......_.,... lGfl k'G�T`EF N :................A -�..!.. ..� �ltR f�No ra... CENSUS TRACT Owner's Name ........... .. !`tGit C� ` ............. t Address _..... , ._.._.... Phone .................................... Contractor's nn � ................................... Nome ........��.�k..,�t'.�4o2BZtsn� ._....�� =i►��,...._...t�, ............................... .... .. -_._.. r......_ !..License # �b a7 i� ��, .. Phone .5 ....'.�.�? Installation will serve: Residence Apartment House'[] Com—ercial-❑Trailer Court 0 �• Motel ❑Other - , ........... Number of living units:.._.a.:.,„-.Nmbe�of bedrooms 3i.. Garbag Grinder .._.._...._. lot Size ... D K•.3 7 4 '” J s . Water 5"' �I Pu � � .... ......................: pp Y: blit S stem and-names.....__ �w Y ---. .......``. Private Character of soil to a depth of 3 feet: Sand E3 _ Silt In Clayi � .•--•--...,._,� _ ❑ Pat 05andy Loam ❑ Clay Loam C] Hardpan,[] Adobe fX Fill Material _..___..._.. If yes,type __.._.....__. I -------------•• 1 (Plot plan, showing size of lot, location of. system in relation to wells, builgs, etc, must be placed on reverse side.) NEW INSTALLATION: {No septic tank ars eepage pit permitted if public sewers available within 200 feet,) 'PACKAGE TREATMENT [ ] SEPTIC TAK ;• .�Siae.. 24.E X..�:3f` .f -•••------•-•--- Liquid Depth r Capacity 12-ID Type 1040 Material �c�,c.��p, No. Compartments 1:1K ^fi t Disance to nearest: Weil�_ .-. p.',._. Q �r � - ---......._..._...Foundation ...--�---•-'•-•-----.. Prop. Line ...:5 ..._....._. t LEACHING LINE No.. of Lines . Length of each Eine._-__?�' 'o F _ ,,. Total Length _._1.7Q_.....--.--•-. . 'D' Box 7 Type Filter Material _-. ' C' .....Depth Filter Material ,1 ........... ....................... . Distance to nearest: Well C� / o .. Foundation SEEPAGE PIT Depth ..c7� I e e ........... Property in � �.��. Y �_.._._.. Diameter f, �✓..... Number ..----A..... ...... ... Rock Filled YesM No [] b Water Table Depth '.` Rock Size p ?- ..................... Distanceto nearest: Well 1� 0„•-_,•• .� Foundation ....60. Prop. Line Y?............. I REPAIR/ADDITION(Prev. Sanitation'Prmlt�# .................. ......_ Date Septic Tank (Specify quire nent�j ... , --- ....•--------------••--•-...... # Disposal Field (Specify Requirements( - ... ...... ............... ... .......... ----------- --------- --- ----•- c - .. ... ........ hereby (Draw existing and required addition on reverse side) . - •-.-..••---.----•••.-••---•-•••-.'-.' y ,ertify that I have prepared this application and that the work will be done in accordance with San Joaquino 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 W rkman's Compensation laws of California.” j Signed ._...... ... ----- ----••".................... Owner BY �._ ------ ... . .......... ..............................•-- . xitle . (If other than owner) OR PARTMENT USE ONLY APPLICATION ACCEPTED ,Bl .. • BUILDING PERMIT ISSUED ...... .............................. .....................:......... DATE .... .. ...� ..7_J�__�....._.._.._.... ADDITIONAL COMMENTS ••-•--•......................... ...DATE ..----...... -•---- ...-•-----••----------•-................................................. ................•-----• =-x--......_...._......----••--- -----.....•--•....................._.........._......... .......................... --- -•--•--•-••--•----••-•--•-----••-- Final Inspection b ............................... ....... . y` .._............ Date . ..yf �. GK7 _ M ; SAN JOAQUIN LOCAL' HEALTH DISTRICT 3 L3 24 I:. H. Z-'68 Rev. 5M'