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FOR OFFICE-01E: APPLICATION FOR SANITATION PERMIT ------------------------- (Complete in Triplicate) Permit No. ---- --- ----------------------------------- 1-77.67 ------- This Permit Expires 7 Year From Date Issued Date Issued ._ Application is hereby made to the San Joaquin Local Health District for a per to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: rz a) JOB ;ADDRESS/tOC;4Ti0 = ---: -- -_J6_6_ __, �..y�.� .- ..__-_—�_:*TCA_r:_CENSUS--TRACT _ �j-w=--'-_-------- IL /+ Owner's Name - �.l LL.[.-P__?---- 4L-0rvS_-'i Q--- ------------------• ------ --.Phone ---------- ------ _ ] D__ _ .__._ _ Add fess --- F r ®' Q. ^' --- -t -- City _^ -='- -Q1C. � -' - --- -� _ `��.p-_ . Contractor's'�Name -�HbL1.1 P'5 A:!:DN57"-__Com,--------------------.________License.# Phone ___ ___________________ Installation will serve:. Residence RR-)�Cpartment House-E] Commercial L]Trailer Court i❑ ) r Motel ❑ Other -------------------------------------------- '' } E 4 � J Number of ;living units:_____1____ Number of bedrooms 3________Garbage Grinder __ _Q:_ Lot Size ____i.�_Q._SC__ oe_____________ Water Supply: Public System and name .I1Tl-!_fi�fQp____k1TR ---`- ------Private ❑ ; Character of`soil'to a'de th of 3 feet:- Sand' . " Silt Cla Peat Sandy Loam Cla. Loam? -- _$ Hardpan ❑ Adobe-E] Fill Material /t!`� 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_seepa pii permitted if pb6lic sewer is available within 200 feet,] i �/ . PACKAGE TREATMENT f[�] SEPTIC TANK[- Size____�__�1._r_f___ _ _______.____ Liquid Depth ---5��=----__- Capacity .12-040------ Type PEI RF_9__ Materiol='CO —K. No. Compartments _-_'Z=_------- iDistance to nearest: Well __-__( --W_`-----------------Founidation __./0___-______ Prop. tine ----�_��.,__-___ I/ J LEACHING LINE—d }No. of ti les _--_�—__._____ Length off each line_T� --_4Q0__ Total Length ___ � i` 'D' Box Type Filter Material '4 CIL-_- ,Depth Filter Materia) ___ ____ ------_------------___________ ! C.Distance to nearest: Well -_W_:-_____ Foundation -----1-Q----------- Property Line ___t�_____`__._.; -- Diameter ---------------- Number �---------------- -- --_ Rock fill,«/ Yes fdo�-.i0 SEEPAGE PIT [ ] Depth ____________ __ - -_-- ❑ �. Water Table Depth -----------------------------------------------Rock Size --- ------ ` IREPAiR/ADDITiOM JP ev. San itation Permit#Wolf______________________________________ flatundation t?rop. LiE►e ._---.--..--------•--- y. # e ------------------- --------- . Septic Tank^(Specify Requirements) _ -:t__' 1t- -------[4A-`'- - -- ��------- ` -------------------------- Disposal Field (Specify Requirements)._ :--------- ------=--- -- -- ---------------------------------------------`---------------------- ------ t i �•�° I,l,�l �-�- --N �w.i r'1.-�..�.fi; � - .-- ----------------------------------3--------- --------------------------- ----------°--`'------------------------------------------------•----------------- ---=-----_-------- - - --------------------`------------ ----------------- -- -------------------------- ------------------ ` (Draw existing and required addition on reverse side) ! I hereby certify that I have prepared this application and that 'the work will be dene in accordance with San Joaquin County Ordinances, State Laws, and Rules, and Regulations of,the San Joaquin Local Health District. dome owner or licen- sed agents signature certifies-the following:._ � 'I certify that in the performance of the work for which this permit is issued, 1 shall not employ any person in such manner as to"become subject to-Work)man'/s C mpensation laws of California." W 5ignecl ----------------- � z5Z-)J� .f '. i - ------ e Owner ; By Title { (If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED-BY _ -; r - = -- DATE _. I T_ BUILDING PERMIT. ISSUED __-_------=-'-----_-._-- - -f iv �t------------- -------- .v - - ---------- DATE ADDITIONAL COMMENTS ------------ -------- � ----------------------------- ---------------------------------- ------ ------ --- ------------------------------------------------------------------------------------ -------------- ------------------ ---------------------------------- -------------------- ------------------------------- -- - ----------------------------------- - ov --- - --- - ------------ ------------- Y Final Inspectio •-------Date --------- - __ __-- ---- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'b8 Rev. 5M