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FOR OFFICE USE: m r� _ APPLICATION FOR SANITATION PERMIT ----------------------------------------------- Permit No. -- �_'Sr (Complete in Triplicate) pate Issued _�`1p._. ______________________ 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 -.49 and existing Rules and Regulations: JOB ADDRESS/LOCATIO L_ _1-__rte____ 4_ R _ G ___.__ESG__[_____CENSUS TRACT 5- '�.... .. Owner's Name D a _( ,Y QRS�,.� r Phone Z5-2-�---- i ��' Address ---------------- ----'----Q D-OK------`j----90------------------------- ----------------- City T�P}`----------------------------- ------------------------- Contractor's Name _©WN ----------License # ---------_-------------- Phone _______________________-__ Installation will serve: Residence ❑ Apartment House❑ Commercial :❑Trailer£ehort Motel ❑Other __________________ -------------------------- Number of living units:_________ Number of bedrooms' -_...Garbage Grinder ____________ Lot Size __A4REAC�----------- Water Supply: Public Swem and-name----------------------- -------------------------------------- ---------------••--------•----------------------Private Character of soil to a depth of33 feet: Sand❑ Si't❑ Clay ❑ Peat E] Sandy Loam-0—Clay.Loam.'[ r- - "-t Hardpan Adobe-E] fill Materia( N __ If yes,type ________________ __________ _. U i (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--7-Al __X____�____-- Liquid Depth__..__----------- Capacity __Capacity _/940 -_____ Type?W9A_13__ Material!_�`_ No. Compartments _____'Z�- 4 � t, Distance to nearest: Well ;____ __ ________________________Foundation ...Z/9------------ Prop. Line __-- ____ - ...... LEACHING LINT: [ No. of Lines / _ ------/___------------ Length of each line____________'___.____-- Total Length ____7J�!_____________ D' Box __ _ Type Filter Material � �1----Depth Filter Material _.______� lr �' Distance to nearest:,,Well ___ __ Y�Foundation `. --------- Property Line -_. . Diameter :). � , Roc Filled Yes �o ❑SEEPAGE PIT G�Depth -_ .________ i Water Table Depth ----- Q i___________ _______Rock Size Foun a. 1 Prop. Line ..5 Distance to nearest: Well ____ 0Q________________________ _ tion REPAIR/ADDITION.SPrev. Sanitation Permit# __A601_______________r__;__�e ,jDpfe j _ _________________________) Septic Tank (SpeEify Requirements) ------------------ ---------- : - -= '1----- '--� /� - .. ' Disposal Field.(Specify Requirements) ______= dC _ _/A!_----PIT----j _____ _!_f�//�--- _..V6 -ADCC----=I --'�_ 4CH a_tU> la-------��° .�� -��M=»- - �d ��tR�-� '�07��----------- A--------------------------- ---- - - - - -•---- --- (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 Disirict. 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 bec e s biect to Workman's Compensation laws of California." Signed Owner By ----- - --------------------=-------- - ----------------------------- -Title ------------ -- - ----------------------------- (If other than owner) ----- -FOR DEPARTMENT USE-.ONLY APPLICATION ACCEPTED BY_---- 4 1 �_ - �: - t � i�i�- `==-----�--'-�N_�_. DATE ---------------------2 ----------- BUILDING PERMIT-ISSUED - - - -- ------------------- - - _ __ DATE' ._ __. _--__-_:---- - ADDITIONAL COMMEI�ITS _ _ O+*,K__-----S7Z, --/SIC--•-If7`-- ---T - n/GH---_�I/O_''(�_.}�_�PROV ----- -t2 TQM CA�!-_ gE_-- ?C- _ ? ?-----T� BJP /�T_F '�----- S-SRC T O R - -- ---� ------------------------------------- --------------------- ---- -------- - -- - -------------------------------------------------------------------------------------------------- -- --- -- ---- C� -- -------------------- - ------- - - - -- --------------------------------------------------------------- - -=------ - --------- Finallnspection b ----- ----- --- - - ---------------------------Date - _ SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M