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V FOS R OFFICE USE: APPLICATION-FOR SANITATION PERMIT :..............................--------- ................ Permit No..�_.� I. p d) ....... This Permit Expires 'E Year From A Date Issued �.�y:73,• (Complete in Tri cat ..:..................................................... p 'D,ate Issued ' i 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: I • .....A...... -.JOB ADDRESS/LOCATON ? Z ........ ....._.....`..... b� . .............................:.............:..:........•-- .........Phone �......-.Owner's `Name ---- i : .-- Address --------- ...................... ................••----- - ._......x,: _ . _._...-...... city S .p.-r- --•- -------...... ............... •-----.License # ` -_..` ._...... Phone _4-16! --- •_:... �:.. cs ._,. ._.Sc?'v5Je 3 3 6' `�6a Contractor's Name ----...........•............ ..._. K - ... Installation will serve: Residence.❑ Apartment-House�[j-Commercial (-]Trailer Court ] Motel [Other �? r[. --..1 ? Fa. Number of living units:...:.-_1.:_ Number of bedrooms ..o.K..____Garbage Grinder '.......-____ Lot Size ...... ....................................... ` Water Supply: Public System and name ,.r..... . ----------------...... ------- ;----- _._...:. ...... - -Private C3 1,-- Character-ofrsoil_to-a_depth of-3_feet: !-Sand Silt❑ .Clay [].- Peat❑ Sandy-Loom {]C —;Cloy Loam- ° Hardpan 1% Adobe.0 Fill Material .------ ---- If yes, type ............`................. ; (N (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 2.0.0 feetj. PACKAGE TREATMENT [ ] SEPTIC TANK Size:..�. -9C?__--Cs��Q .......:....... Liquid Depth ...._` '_'. 1.? N V-- ' :�`_ Material&q t No. Compartments' b.......... ' Capacity --IZoo---•--... Type -------------- .__.. •----• ----. Distance to nearest: Well .Foundation ..... Prop. Line ............. LEACHING LINE [ ] No, of Lines ---------a........ Length of each line....... ............. Total Length ..:f0�___._......... 'D' Box .__ . �__-'._ Type Filter Material ��: ......-Depth Filter Material ----------------•--•-----••................. Distance to nearest, Well-......!96:t___.__. Foundation ----- ............ Property Line ....... ........... s SEEPAGE PIT . [ ) Depth ---. 5..----__ Diameter :.... J'.�_:._ Number ....---a............... : stock Filled Yes j� No !] Water Table Depth .3.......................................Rock Size _..� ' x� -- Distance to nearest: Well:...........:. .. .......................Foundation _..___.__... .__.... Pr t --3 I oa � Fo !p� � op. Line IQr REPAIR/ADDITION(Prev. Sanitation Permit# ----------------- ........................... Date ................. -----._____---_-) I Septic Tank (Specify Recjuirements) --•---- Disposal Field .(Specify' Requirements) ................ 1-1 3 ash T 'ti.. t.` ................. ------------ ----F----------•-------- ------------------•-----_...---------.__-_----•-•--- . ------------------------------------------ - w,r ' .R}r.."'...."•�"," - - - �. 't-- .mow.�•"P""� 1 ._...--•......... ....:.................................. ............ ......:...............•------•--- .___..... -------:...... (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. Howie owner or licen- sed agents signature certifies the following: "I certify.that in the performance of the work-for which this permit is issued, II shall not employ any person in such manner as to become subject to Workman's Compensation laws of California." , Signed .._ ....... ---- Owner ^y By ------------- U-- :.: Title: f ------- = ............................ (if other than owner) FOR DEPARTMENT USE ONLY- ? APPLICATION ACCEPTED BY... ... 7 .fl-.� ` - t .. DATE ... - »./.. .:.7 --.-. = BUILDING PERMIT ISSUED ............... • ------•------- - ..................... DATE _.... _---_._....-----•---.... ...... ... ... ... ... .. ADDITIONAL COMMENTS . :.:' :.-_ . ---- ----- :._..°...................... F .................................•- ---- -•-- •-•-------:-- - •---• __ -•--........---...... ....... .. ...........I----- ..-----............._..._.______.._.._.. . _._ • .... .. ..............••------------------ ..... . ---- 7 Final Ins Date ... .-r-•-�.. ...1... SAN JOAQUIN LOCAL HEALTH DISTRICT ' r E}i{_13 241-'6B Rev. 5M 7 LSI