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FOR OFFICE USE: �' w �� .- l Permit No. 7/ W m APPLICATION FOR SANITATION PERMIT - -( (Complete in Triplicate) ---------------------------------------------------------- I! i � -i Date Issued ___4t ��` _------------- 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: JOB � ADDR�IEs�Ds/LocATION _30 /�� -----A&_ � _ ----------- - .-__-_-- CENSUS TRACT -----��----------- Owner's Name ------r7�_'&r- A<-19-- -------=-•------------- - Phone------------------------------------- i ---------------------- •--------- ' p � % Addressj s .-') Contractor'sName ------ ---------- ---- ------------------------ ~ =---------------•------ .License #� --�'��-w��.-E'r-'-- Phone - i G Installation will serve: Residence XApartment House❑ Commercial:❑Trailer Court ;❑ I I� Motel ❑Other -----`--------------------------------- -- g cl / Gr. �/ Water Su I I wing units:_-__.______ Number of bedrooms ________Garbo a Grinder .��Q_ Lot Size _ -------••-- Number of I i � p Publics stem and name _ _ _____Private ❑ Character o soil to a depth of 3 feet: Sand'❑ Silt fl,,,,,,. Clay ❑ Peat❑ Sandy Loam -❑ Clay Loam ( Hardpan E] Adobe -,,Fill Material _.___-- --- If yes, type ___.___--_________________ F (Plot plan, showing owing 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` ,) available within 200 feetf` PACKAGE TREATMENT { SEPTIC TANK' Size Xa� _ ------ ___�___Liquid Depth '-------------- b �.}�q P p _ T >/Material � Q------ No. 'Coin artments �----•_ ] y ------------ Capacity -------------- - ype/ Qz r Distance to nearest. Well _--------------------'--------------Foundation __l '~_______ Prop. Line __....-- LEACHING LINE , No. of Lines -----/______________ Length.-of--each _�a- line- ----- =_ Total Length%.4 � ' f D' Box i Type Filter Material __! ! Depth Filter Material !fit ' /1'..t7 Yp �� i i --------• ! f Distance to nearest: Well _---- Foundation _ ___ �-----------JProperty Line. Nog SEEPAGE f SEEPAGE Pi ~ �__ _ock Fi led Yes ` No T Depth tx Diameter = ry !C / I Water Table Depth ___ --- __ Rock iz �---�-- '------- Number ----------- r 1. to nearest: Well -- ------------------------------------Foundation ---- ------------ Prop. Line ....... i EPAIR ADDITIONSanitati Distance R / (Prev.I on Permit# ----------------------=--------- ----- Date -------- ----------------------- S ----------------•------) . l " (Specif Re uirem Dis i Tani Y q ents) ----------- ----------------------- ------------------------------ Septic Tan �+ p Is ld (Specify Requirements) ---'x7 -f f ��'' t f - � f- ZV -----=------------------------ -----A_--- i ------=- ------- ----------------------------------------------------;-F{------ ---- -------------- ------- ---------------------------- I s (Draw existing and required addition on.reverse side) r,,,,� I herebycertify, that I .have prepared this application and that the+arkwill be ,done in accordance with Sang Joaquin �►,,!` 'fit u4in County Ordinances, State Laws, and )Rules and Regulations of the San,Joaquin Local Health District. Home owner.or licen- I sed agents signature certifies the following: r "I certify that in the perFormance'of the work for which this permit is issued,,Ll shall not employ any person in such manner as to become subject to Workman's Compensation'I s'of California. SignedIS-------------------------- ---- -- ------------- ----- ---- ----- --------= Owner �M BY ------ t------------------------- -------- Title --------� j n------------------------------- I: (If other tha ner) 1 EPARTMENT USE ONLY -4 4 . DATE _-. _--2_j_T 71-------------`-- APPLICATION ACCT=PT BY --- -,' -- ---- - ------�_-r------------------------------------------------ BUILDING PERMIT ISSUED ----- - = ---------- --------Ir ---.---DATE -------------------------- ---------------- ADDITIONAL COMM T ----1 ; -A ------------ - ---------- -'-'----------------------------------------------------------------------------------- ---- -----------•--` _ 3 7 _ �--------------------------------- -- ---- - - - - - - - -- II /- -____--- --------------------------- ---------------------- ------- -;----------------------`---------------------------------------------------------------------------- -----:-----------------------4-------i Final Inspection by: ----- ----- ------------------------ --------------------------------------------------Date - ._ _ 7------------/'; SAN JOAQUIN LOCAL HEALTH DISTRICT i E:H. 9 ill-'6 Rev. 5M.