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FOR OFFICE USE: .. -- APPLICATION FOR SANITATION PERMIT 7 Z G (Complete in Triplicate) Permit No. ----------I---------------------------------------------- _________________________________________.___________ This Permit Expires 1 Year From Date Issued Date Issued g3YL 7.� ON Application is hereby made to the San Joaquin L�cal-Health-District-for -a.•pe?mit to construct and install the work herein described. This application is made in compliAce with County Ordinance NU.Z49 and existing Rules and Regulations: r i JOB ADDRESS/LOCATION .__-203-3---Li-lo _lci----- --'--- - ---•- -°--- �._1_ "--- CENSUS TRACT --- Owner's Name -----F—r- iylk---Oal-1.J--------r------------------I----------------------------------------------- I---------------Phone 4 ----92-------------- Address --Same ---------------------------------------•------------------ ------------------------------ City _Stkn-t,----------- ----- Contractor's Name ----131aCkaxd'_S j.S_ept_ic---Tank--------------------------License # 26B951----- Phone 44.3-!,-7-348_-------- Installation will serve: e Residence f] Apartment House,❑ Commercial [-]Trailer Court Li !tY Motel E] Other �------------------------------------------ Number of living units:__ Nur`nber of bedrooms ____3._____Garbage Grinder --------- LotSize _100_'_X20.0_!__________ -------- Water Supply: Public Sys4m and,name -------------mit ------------------------ -------- -•-•-----Private ❑ \ f 37 I I Character of soil to a depth of,3ifeet: Sand'[] Silt o Clay ❑ Peat❑ Sandy Loam ❑ Clay Loa ❑ Hardpan ❑ AdobeXg 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,) #f r PACKAGE TREATMENT [ ] SEPTIC TANK'[ ] Size--------------------------------------�______.\_ Liquid Depth -----------------I------_, CaCapacity .___ _ No! Com V p tY -------------------- Type - ------------------ Ahateri_-------------- Compartments ----------- --------- RR Distance to nearest: Well ---------------_______ _____________Foundation ------------\1----- Pr-op. Line __......... V LEACHING LINE ] No. of Lines ...Z___________________ Length of each line.----__3Q-___________.__ Total Length _30_'___------------ 'D' ___----. --'D' Box ___1______ Type Filter Material __---------2......Depth Filter Material _' _]Ly -------------___________}_..__. _________ Foundation ------------------------ Pro er Line ___30_1 Distance to nearest: Well ____.____"_"' 10 p ty .. ........... SE'EP*GE•-PtT �] Depth --8 ------------- Diameter 5'_ �0-�_ Number --_-_1---------------.--. Rock Filled, Yes ® No �r ump-- Water Table Depth ----------'�- 0-� ..._..Rock Size ----2u----------- C " - ____--Foundation � f Distance to nearest: Well ---------------- 20------------ Prop. Line -----±---- a_.._.. REPAIR/ADDITION(Prev. Sanitation Permit# ____________________________________________ Date ---------------------------------- Septic __-___________________Septic Tank (Specify Requirements) --------------------------------------------------------------------------------------- ------------------•-' ...... Disposal Field (Specify Requirements) ______________3a_1-__Leach Line & Sump j'X8•X1,0' - --------------------------------------------------------------------------------------------------------------- ---------------------------------------------------------------•---------------• -------- ------------------------------------ ------------------------------------------ ----------------------------------------------------------------------------------- -------- (Draw existing and required addition on reverse side) a 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 "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 become subject to Workman's Compensation laws of California." I Signed r ----- Owner ------------ ------ --------------------- - ------------------- ------------------- Title ------ --------------------- = ----r --` ------------------ --------------------------------- (if ----- -------- (If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ----------------- -----------------------------------------------------------------. DATE T.-- _?-----r- E BUILDING PERMIT ISSUED --------- DATE --------- ADDITIONAL COMMENTS -- -- c-c----.C.rr .tr�<---�� - rut --- ,5 - -- -+�---- -- - - � --: --- -- ------------------ ----------------------------------------------- --, -'� " ''t Cl 'i` rr(°------- --�------ ---- --- --------------------- ----------------------- ---------------------------------- --- --- - ------------------------------------------------------------------------ I- Final Inspection by. ._ ----------------------------- Date - .. SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'6B Rev. 5M C.�d-