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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ,�/ L9j 7 {......................................................... Permit No. 11 J 17 (Complete in Triplicate) r........................ . ................ Date Issued«'/4.'7 .. ................ This Permit Expires 1 Year-From Date Issued '� t 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: J08 ADDRESS/LOCATION ............ ........... . ....._..... .1�_ _................. ............................CENSUS TRACT .:........................ ��.. 1t1l rel � / ..� - -- - ---....�r 4 ................................Ph n Owner's Name -- - -- ------- o .' ....,el�.-......... Address _-._.s4A,94-----------------------......--- ----- City :.. .. _ .... .. yContractor's Name ... 1/.Z '. ..,5 , Z1 .Z',IVIC..:,�.I�.........:..License # ...... Phone ..... . Installation will serve Residence Apartment Houser❑ Commerc'Fal-'eTroiler Court-'I]. - f Motel ❑Other -------------------------------------------- Number of living unils:..l.___... Number of bedraomsr:_:....Garbage Grinder,&O....._ Lot Size ��..�.................. Water Supply: Public em and name................... `: Private Character of soil to a depth of 3 feet: Sand❑ _Silt❑ Clby ❑ ' Peat❑ Sandy Loam ❑ Clay Loom ❑ #' Hardpan ❑ AdobeFill Material ............ If yes, type ........... .....•-.._._.... h (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 I#�ublic sewer is available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK M ................... Liquid Depth ,5...m................. Capacity/ 1�: Typi �/ . Material ' No. Compartments Distance to nearest:-Well ...c. 7.. 3` .................Foundation Prop. Line . LEACHING LINE ) No. of Lines . .:. ............... length of each line.................. Total Length _106.............. D' Box .. Type Filter Material kvc;k.......Depth Filter Material -f11.. .............................:... /fir Distance Wnearest: Well : . .j .•.....;..... Foundation ........................ Property .Line .7.1............... SEEPAGE PIT Depthc-;7_._-r...J........ Diameter 1.117......... Number Rock.Filled Yes 2) No ❑ WaterTable Depth --•- C? ......-•.. ......:....>,.,.....Rock Size .11A. �.�f.....:...... . . • Distance to nearest: Well' ': ..f�...........................Foundation .1d.t...:._--..._ Prop._Line J.............. : 41 REPAIR/ADDITION(Prov. Sanitation Permit ` _. . ................................. Date ..................................) r Septic Tank (Specify Requirements) Z, r -•---•........................•---••-•--••••---••-----------•..........................•-----................_..... Disposal Field (Specify Requirements) ............................................................. ---------------------- -------------------------------------------- _.____-_..._._............... ... - .... ................... - _ ......-.... ..t..........._....._..................._................_..........._....-.._..................._....._._..... (Draw existing and required addition on reverse side) I hereby certify tha5,,I have prepared this. application and that the work will be done in accordance with San Joaquin ' County Ordinances, State Lowt,`and Rules and Regulations of the San Joaquin WWI Health District. Horne`owner or licen- J. sed agents signature certifies.:-thRe'fallowing: "I certify that in the performance' f the work for which this.permit is issued, 1 shall not employ any person-in such manner as to become subject to Workman i' Comp/- ,., nration lows of California." Signed ' .. Owner 1 ;.By ..............................(........ =-::.. Title .(if other than ner) I F It_DEP_ E. USE O A, APPLICATION ACCEPTED BY .. . }... . ........... . ...__... ................ ......_ DATE`.Z.a.:�/_.'0 7 ............. BUILDING PERMIT ISSUED -•---- �i �.� ...:.__.. DATE. F ADDITIONALCOMMENTS ....................................................:._._........ ............._..............-•• :.......: :::..:.'.:._... ........................................ ----- ••• ....................... ---......----- . --------.....................-•-•--------................--•--•--•--......_.......... ................I..........._......... ......... .. ---- --. ..................... .....................................................•........... :�...............------------ ... .- Final Inspection by, ...... :.. ..:............. .:::::............... ...................... _.........Date . _ SAN JOAQUIN LOCAL' HEALTH. DISTRICT 13 24 E. H. W68 Rev. 5M 7172 3 M