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FOR OFFICE USE: •f � w APPLICATION FOR SANITATION PERMIT permit No: ' " W --- -- --- ----- ------ - -------- ---------- ------ (Complete in Triplicate) ----------------------------------------- Date Issued _ -_(�--7--- ` This Permit Expires 1 Year FronaDate 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: elf A ' "574V4?k Al_CENSUS TRACT -- 5-4--------------- JOB ADDRESS/LOCATION . ' � A)e4 � Owner'sName r � 77Gf�----PR49_PIF — _----- : f C -------Phone ----------------------•---------- AW Address ° --- -- --9------ Contractor s Name _-PA A e l-S_t4 ---- � N'� f N --------------License # -� CJ.S"f I Phone Installation will serve: Residence ❑Apartment House❑ Commercial ❑Trailer Court ',❑ Motel CR Other --�T-AiLfP_A_aT_--- 5�2V ICC S7�F ' Garbage ------- Number of living units:_______---_ Number of rooms _________ _ ge Grinder _________-_ Lot Size ---------------------------- ---- s Private Water Supply: Public System and name - ---�A)- ' C' ❑ Character of soil to a depth of 3 feet: Sand'❑ Silt Clay ❑ Peat F1 Sandy Loam ❑ Clay Loam:❑ .-Hardpan ❑ Adobe';, Fill Material ----- ------ if yes,type ----------------- Plot Ian, showing' size.of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) ` [� [ p NEW INSTALLATION: d,size. septic tank or •seepage pit permitted if public sewer is available within 200 feet,) \\\ 3 t PACKAGE TREATMENT [)k SEPTIC TANK'[ ] Size-- -- -------Q.-----------• Liquid Depth ---------------- ----- #� CapacityA_/,00� --- Type -----:--=------- Material_�MP----------- No. Compartments D-)------ t Distance to nearest: Well __/1lJfJ'W�----------- Foundation _1 �f+f -------- Prop. Line --- ---:.----- LEACHING LINE [ ] No. of Lines ------ ----------------- Length of each line---- .--------- Total Length -------------:------------ 'D' Box ------------ Type Filter Material --------------------Depth Filter Material ----------------------------------•--------- I' Foundation __ _ Property Line -----------------•-•- ` Distance to,nearest: Well ____---________-- ��tl Rock Filled Yes' No i❑ Ql--- Number C7- -------- --=------- . �. SEEPAGE P!7 � ��^- Depth _�_-•��_ =--____-- Diameter _---------- - �— x-�" Z 3Rock Size i xZ_ ------ Distance Table Depth ��-------------------------------------- Distance to nearest: Well L��1��---�---------------- -- •- -Foundation ------- Prop. Line ---------------------- i --------------- Date "-'"�--------- REPAIR/ADDITION(Prev. Sanitation Permit�# ---------------------------- Septic Tank (Specify Requirements) -------- -------------------------------------------------- --------------- -------- .��7 way f1 J�'�/.} `/ - Disposal Field (Specify Requirements)1 �f�f am Q [I L ¢ Tom "__ 4 / (Draw existed required addition on reverse side) I hereby certify that 1 have prepared this application and that the work will he done in accordance wit San oaquin 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 nlerformance of the work for which this permit is issued, 1 shall not employ any person in such manner as to become sub pj"o Work an's Compens tion laws of California." ne ---------/- '----------- Owner Sig 4 S ----- Title . � ---------- ---- ---- --------- --- - -- �- (f of er than owner) ARTMENT USE ONLY f ------------------------------- ------------------- DATE -- APPLICATION ACCEPTED BY ___._ _ __ _ -- - --..------ ---------------- ---------- ---DATE ---------------------------- -------------- BUILDING PERMIT ISSUED .--____-- -- ------- - -- ----- ---- - --------- - ADDITIONAL rte! N ----- --- ---- ---------- --------- �' -- -------------------------------------------- --------- ---------'T-�-------------------------------- J-- _ c 0 - --� a �/f i� f- � ' y &-------------------------- ------------ Dat -------------------- ------------------- 1l�i'nal Inspection/%: -----------�-,-4-----/---- ---�-j-----`- ------------------------ `-- ----------'----�- -/-- -------- - 4 ------------- ------------------- QISTRI 00411 rAL H E. H. 9 1-'6$ Rev. 5M i