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APPLICATION FOR SANITATION PERMIT ---- -------------6.—a-- Permit No. G_�5 11-10 tea- (Complete in Triplicate) --------------------------------- --------- This Permit Expires I Year From Date Issued Date Issued ..0/Zy..� J7/—1 Qro--oS 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 ul s �ncl Regulations: JOB ADDRESS/LOCATION C,I i Yr2*ra- ..... .. ....f..�s i----- ^C S S A Owner's Name '- •---- . .._.. Phone ................ ... Address gc ;---------------- City f�/u - •----•-----•------------_--- Contractor's Name ................ _ __07_Z4 y:_ Y -__.License # ,113- j__.�Phone�.___.._._.__.__. . --- -• ------------- Installation will serve: Residence ❑'Apartment House fl-Commercial ❑Trailer Court 0�_ y f Motel ❑O-ther -- --- - ----^---------- ---------- Number of living units:_J6 -------- Number of bedroorrK� �_G 2r age Grinder ....`....� LotSize _._. 1_lzQ2a4. ._ _ ....._. Water Supply: Public System and name . � -� _v--- _�--------------- ---Private E� t• ; CharacterOf soil to a depth of 3.feet: Sand , SiltD ✓Clay Peat " a dy Loom ❑ Clay Loom.[ Hardpan-�, Adobe ,ill Material ------------ If yes,type ____________________________ (Plot plan, showing size of lot, location of .system.�in` relationfio wells, buildings, etc. must be placed on reverse side.) s NEW INSTALLATION: (No se tic tank or se p ge pit permitted if public sewer is, vailable within 200 feet,) PACKAGE TREATMENT SEPTIC TANK: Size J_'J K . y / [ � Liquid Depth ----------- I Ca Capacity. � , Material_. .. �� No. Com x'_...____: P ty= - Type - -- - Compartments i stance to nearest: Wel! _SO Prop. Line�.. . .4, LEACHING LINE [ No. of Lines _..._.._� _.____.._.__ Length of each li e._.___)f!llrlt____.__._ . Total Lengtthcc.�i............... D' Box __ ___ Type Filter Materi G �epth Filter Material .-_-_.__l-Q.____t�........................ Distance to nearest: Weil ` Foundation ld Lei r . S _��,r Property Line ,______.. SEEPAGE PIT [ } Depth ___----------------- Diameter ..--__--___- `-*Number ....... -------- ---- Rock Filled Yui'❑ No �] Water Table Depth -- ----------- - ----- -- -- ---`......].Rock.Size -- ----- -- - --• : Distance to nearest"' ........:.... _..__!"t"'[._�_Found�n ....._.............. Prop.-..Line".__...., .....__.. REPAIR/ADDITION(Prev. Sanitation Permit# . .............................. Dbte="`$-_..--.__f_______________ Septic Tank (Specify Requirements) --------------------- r - + .�. ! E r' !! I Disposal Field (Specify Requirements) - F------------------------------------- ------\...... -. - -- -------- ------•- -----------------------------_----- ------ ---------------- ------------------- ---------------- - ----- ----------------------------------------------------------- \! -- ........... - (Draw existing and required addition on reverse side) accort �. I hereby certify that I have prepared this application and that the work will be done in dance with San Jaaqum County. Ordinances, Stafe`Laws;-6nd Rules and Regulations of.theSJoaquin Locah . can .Health District. Home owner or licen- sed agents signature certif;es•,thelfoflowing: "I certify that in the perforrKance of the work for which this permit is issued,`I shall not employ any person in such manner as to become subject to Workjman's Compensation laws of California: ~l_.f Signed .. .- :' ..__.: --------- ---------- •-- ._..... ..... _.:'Owner BY ............. ................................. ----------- Title --------- f (If other than owner) FOR DEPARTMENT USE ONLY •`� APPLICATION ACCEPTED BY ----- _. _.... .P, .-/ ,I,7�ru. 1 .-�_'----__-- . DATE __1.6_`/17.1G................. BUILDING PERMIT ISSUED - "--:_-_-- " " � • _DATE ............................I.........-..-_ ADDITIONALCOMMENTS' - -- - - ------ •-•--•----�- ------ ------------h------------ - . .-- -�---- -- ----- ------ --- --- . - - --- .......................................................� -- ::---• ------------------•.:------•---•-----------•--------------•---------•------------ --- - {�g.-----------•---•--- Final Inspection by: ---�---•---•---••--•- ......Date ._.. rCQ(U... SAN JOAQ61N LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M