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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ----- 3 (Complete in Triplicate) Permit No. .__�_-------------- --------------------------------------------------------- __ This Expires i Year From bate Issued Date Issued -,7-?---- ' - -- 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: JOB ADDRESS/LOCATION /-S___ --1/_ W�S�`3 � SUS TRACT __.-____.-___._ , -. Owner's Name L R ` �G=1` � _ ----------Phone ---------------------------`------ c L ------------- / Address 1 /�l1_ _/ lr- ?✓ City ------- FC6� '- Contractor's Name .__.____ �.L,..__ _=tl ------------- --'-- ---- C------.License # 5�`� I' Phone _ Installation will serve,_____._Residence [ Apgrtment House❑ Commercial ❑Trailer Court ❑ _x y Motel ❑ Other ------------------------------- ------ - r Number of living units----1------ Number of bedrooms ---5-----Garbage Grinder ------------ Lot Size -/s? ------ Water Supply: Public System.and name --------------------------------•------------------------------------------------------------------------------Pirivate Character of soil to a depth of 3 feet: Sand'E] Silt❑ Clay ❑ Peat❑ Sandy Loam ' Clad Loam El Hardpan ❑ Adobe-❑ Fill Material ------------ If yes,.type -------------!-------------- (Plot -- --_(Plot plan, showing size cf 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.T NK [ ] Size---- 4Xg._ -:--____ Liquid Depth _.�7�_----_---.-_--. !I U_____ Type Materia!________________ No. Compari�ments7 ---- Capacity . 4 � -- -- - 1 Distance to nearest: Well __!�__ __________ _____________Foundation _ _ ___--__--_-_ Prop. Line ___ ......... LEACHING LINE [ ]' No. of Lines Length of each -line--- 611 Total Length b2_l0--- 'D' --'D' Box ------ Type Filter MaterialDe th Filter-Material; _��-----_---_-_-____�------ P Distance to nearest: Weil _ s --- FoundatEon _ ____.___..__ P tv Pro er Line `� _ - 9 SEEPAGE PIT [ ] Depth -------------------- Diameter __=_------------ Number -------- No___ Rock Filled Yos ❑ No 0 -� V ater,.Table Depth ----------------- ""' -Rock Size ------------------------- i Distance to-nearest:Well __.____-__________-__ . ----------'------Foundation . ,> - ------ -- Prop. Line --------------------- REPAIR/ADDITION(Prev. Sanitation Permit# ---_._ _._ _------------------------------- Date --------------------------- ...... i Septic Tank {Specify:Requirements) ----- f ---- __ --------------- ------------------------------ ----,-;--------------•------------_ _____________________________________ Disposal Field (Specify-Requirerrients) -------j'•--•---------------------------------------------------------------------------------- --- --------- ----------------------- ---------- ---------- ------------------i------ --------------------------------------------------- - -- i -- -------------------- ------ - - - - - - - - -------------------------------- ----- --- (Draw-existing-and required addition on reverse side) F -I hereby certify that ! have prepared this application and that the work will be done in accordan e{with San`'-Joaquin County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. home ownerlor licen- sed agents signature certifies the following: i "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 I Wo mans Compensation laws of California." Signed --- --------------------i------------------------ Owner I By -- Title ; i (If other than owner) ; ! FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ------------ r -f ------------------------------------------------------------ DATE 'e! f� ` "' BUILDING PERMIT ISSUED__........ - - _n..-.=---�----��- --------- ------_-•----�- --------�-----•._--•----------DAVE --------------- ADDITIONAL COMMENTS _____________________ - ----------- ------------------ ----------- ------------------- ----------------------- _-------;%;{ ---- -- --- --- = -: - - . -- -. ...`.,_..��T--. �.aP...:-....�,..� ..—w 1. Final Ins ectian b ---------------------------- ----- Date!_- --�" = -: - P Y' -- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M ' - f