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FOR OFFICE USE: _ APPLICATION FOR SANITATION PERMIT .- ....._.-. (Complete in Triplicate) Permit No. _. r._.1s: � Y t .......•.......................... Thls Permit Expires f Year From Date issued 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 applicat5 i ion is made in co pliance with County Ordinance No. 549 and existing Rules and Regulations: .JOB ADDRESS/LOCA N ! . . - ........... GENSUS TRACT ..........................Name ..... . Address ............ ' -• --- ------- r ..... ......Phone 6` '3 ........ ----• ........__.I— City r 4-- ................. Contractor's Name ---•---- ! ----•- ----------- --- - ----p __...._..Lloanse� ��.�z_�.3._ Phone �-F�oQ Installation will serve: Residence j',�A artment Housefl Commercial oTrailer Court 0 ' Motel ❑Other__. ..._.. Number of.living units:... Kk"- Number of bedrooms __-'5iL._Garbage Grinder -._ Lot Size Water Supply: Public System and name;_.:______. _ ........:.__....... .........Q . .........................................Grsy Loam ❑ ate ice._._.---+ .� � Character of soil to a depth of 3 fee#: Sand ---,I Silt Q Clay 0 Peat Sandy Loam fl Hardpan Adobe Fill Motterlal ------------ If yes,type............... ...... (Plot plan, showing size of lot, location of systerrmcin 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,) r PACKAGE TREATMENT SEPTIC TAMC{-I� � ze._Q Liquid Depth -�� r ...x_... ._.-��_........_._ -..--_.-_-_- I Capacity -IMV_Er-Ply ---_... � ••- TYF� -- ---•---5-------- Material..._-- No. Compartments ...��.'.._..... Distance to nearest: Well . ft.............Foundationl_Q__..----_.. Pro Line -• LEACHING LINE No. of Lines ..... - % I ---_ Length of ch line...•_--_�.._ -6-0 ' i •-------- ,y(�Q .... Tota! length 'D' Box -. -•------- Type Filter Material ......--- ...Depth .Filter Material ......A..." 6 Distance to nearest: Well _-_/C111._�.7` Foundation _....�4_..�.t--•-- Property Line ... f' SEEPAGE PIT Depth _--. S.. ...... Diameter ��". _`Number . "-' '--- _--..Z................. RockrFilled Yes No 0 Water Table Depth .................................................. 3� Rock Size t� �..�/�..--•-- (O Distance to nearest. Well f_. ' ..Foundation ...1'D_...r..__ Prop. Line —f.Av.........4 REPAIR/ADDITION(Prey. Sanitation Permit# .............................. .......... Date Septic Tank (Specify Requirements ` 3 Disposal Field (Specify Requiref6nts) ._.. _._ - --------------- ---•---- ---•-------- ----------- ---------- I 1 l ............----------------------- raw 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 Sart Joaquin County Ordinances, State Laws, and Rules and Regulations of the San Joagtiin`Local Health.District. Hattie 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 become subject to Workman's'Compensation laws of California." I Signed -----•-------•-•---- Owner BY --•-- 1 --• ---------••--- Title --------- - ---•-- � . other an owner --------------------------------- (if , FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY BUILDING PERMIT ISSUED ------- --• __ ----- DATE ADDITIONAL COMMENTS _-_-• - �-.t?ice �•. . �,p- ----------------------------- wc. r ----------------•---••-•-- -•--------- ....................................... ---------------------------•----•--- -----•------- - a.--1••------- ------ .------------.................................... . .. ........••-- --•--•-••--------------------•--•...................- .- --------- -•- 0- . �,t ---- ina Inspection b f _ p Y �_,. ..-.._.-----_--------------------------------Date - Eli 13 2h 1-513 Rev. 5m - - -----�--------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 8/7h 3M