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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ,a- � -------------------------------------------------------- (Complete in Triplicate) Permit No. ----------.._. ------------------------------------------------------- Date Issued --------------------------------------------------------- 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 r i nce No. 549 and xisting Rules and Regulations: 3W gasaon goad;; JOB ADDRESS/LOCATION ._ _ 16__gfl S n6 r].V r__^� T]_-- O QC ,q- j V4r_.i 151 11S T T n Jo�9.u- �iver r✓lug --- Owner's Name ------- C _H-•--_TRIPP --- - -- - -- -- _- ----------- ---------- ------------- -------- ---------Phone ------------------------------------ Address ---412 _P'-�P ---St�------------I-------------------------------- ----------------- -------------. City ---Pleasentm............................................. Contractor's Name ---P 7-ma—Wort__PI ing__SSQc_ ------_------- --------License #991-�'----------- Phone -- 35!4124..---- Installation will serve: Residence T4partment House❑ Commercial []Trailer Court Motel ❑Other ------------------------------------------- Number of living units:________ Number of bedrooms ---Il-----Garbage Grinder _1Qo____ Lot Size __,520!_X-.100!'................. Water Supply: Public System and name ______________C-0mm nitY__{_sm-ioaqu-_-RjVer__C,1UbL)-______---Private ❑ Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam JX N%, 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 seepage pit permitted if public, sewer is available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK Size_.51Z%x ----------------------- Liquid Depth --- R'......._...... Capacity .1200 Type .Pre-Cg'g MaterialC"©11Cr @ No, Compartments 2.......... ......... Distance to nearest: Well __3i00t------------------------Foundation _-1.0+_------------ Prop. Line -----15 ......... LEACHING LINE No. of Lines ------- Length of each line-I__716-411671P----- Total Length ,__9Or.................. W 'D' Box ____ Type Filter Material S_ePtloRkDepth Filter Material --------19--------- - ♦� Distance to nearest: Well __3CPt------------ Foundation ----15T------------- Property Line --------5f .SEEPAGE PIT [ ] Depth -------------------- Diameter ---------------- Number___________________________ Rock Filled Yes '❑ No 0 Water Table Depth --------------------------------------------,.Jtdck Size -------------------------------- ddd Distance to nearest: Well _______________________________________Foundation __________________ Prop. Line ---................... REPAIR/ADDITION(Prev. Sanitation Permit# --------------------------------_---___---- Date -_--------.--_.-__-_____.--.._____) SepticTank (Specify Requirements) ------------------------- -------------------------------------------------------------------------------------«--------------------------- DisposalField (Specify Requirements) --------------------------------------------------------------------------------------------------------------------- ----------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------- --------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- (Draw existing and required addition on reverse side) I hereby certify that I 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 he work for which this permit is issued, I shall not employ any person in such manner as to become subject to Workm 's C mpensation laws of California." Signed ----P: LMITIST PLG - VICE BY - TitleTl6T ----------------------------------- (If other than own FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------- ------------- ----------------------------- r - ° _, ---. DATE ----- --------------- - ------ ------- ------ - - BUILDING PERMIT ISSUED ------------- ------ ------------------------ ---- ------------------t --- - ----------------- DATE ------------- ------------------------ ADDITIONALCOMMENTS ----------------------------------- ----------- �--------- --------- ----------------- --------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------�---------------------------------------"- - ------------- ------------ ------------------------------------------------------------------------------------------------------------------------------ - ---- - -- ----------- --- -- ------ Final Inspection by: -------------------------------------- - -----------: ----------.Date --- --�� :-��-- - SAN JOAQUIN LOCAL HEALTH STRICT E. H. 9 1-'68 Rev. 5M