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10[050� IOWA FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT 1�J�� v . ......*�.................. ... ............... Permit No. ... ` `........ (Complete in Triplicate) ............................................. Date issued ..3:��-..�--•- i This Permit Expires 1 Year From Date Issued R E. _ �.��gr��:.�, .2.J - r I /103 —/[oa ,,2 al -�6 V in locHealth District for a permit to construct and install the work herein plication is hereby made to the San Joaquin described. This application is made in compliance with County Ordinance No. 544 and existing Rules and Regulations, JOB ADDRESS/LOCATION . /. .....6�.�s� r�� := .. "�' '-�`.. , ' ?�"= ;.CENSUS TRACT .......................... jj Owner's Name .......... ....... c ._...Phone ....-•- ...........•c-P. . .... Address ----- ............. . ../ ...1 F? �r,� .., ................... --.... City -_ms s ..................;................................ Contractor's Name ...... :.. :...� � tf:.._ .....--` --_= ------ License # ... ._. Phone ... 6is-�.:. -'`.1.... y Installation will serve: Residence (�Aportme e M CommercIaI QTraiter Court 0 ; t Motel ❑Oth '9 e ............ ' Number of living units:.......L_ Number of bedrooms -_=7.....Garbage Grinder -___... ---- lot Size_,...._ .. : R- Water Supply: Public System and name ...........'`.::........................--..-- -..... .j-- Private Character of soli to a depth of 3 feet:- Sand t. -Silt❑ -Clay �`Pegt❑ Sandy Loam ❑ Clay Loam ❑ Hardpan [:] Adobe Fill Material ....---- IF yes, type ................i.----__-... IPlot 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 200 feet,) r PACKAGE TREATMENT [ ] SEPTIC TANK D4 Size.... ? = -,�_ r---.-•••• Liquid Depth _.. `r�'..�� $� � s� u�— '-mss Material.._.' V"'_.1- �: No. Compartments -"-......... Capacity •�----..... TYPe ----�.............. ----•-•----...J Distance to nearest: Well .._.. f. ................Founddtian ------f_.Q.'':.--.. Prop. Line ... ...... ........ s LEACHING LINE ( No. of Lines ...--- ,-.._--.��..f Length of ach line.-------f-T............. Total Length _��.. ---------------- 'D' Box .....f----- Type Filter Material ." :......Depth Filter Material .....j ...................•-...-•---::.. D Distance to nearest: Well ...._. { ''�__.. Foundation ... _ r' Property Line ....:.....: . SEEPAGE PIT [ j Depth ---2p - -------- Diameter ........... Number ._.. ....... .. .... Rock Filled Yes _ No •..................Rock Size ..... • Water Table Depth .--------:��...:-------• _...!�...�`---�r-....._ Distance to nearest: Well ..........�. ........:..............Foundation __ Q ......... Prop. Line .-s ___-----_•-- REPAIR/ADDITION(Prev. Sanitation Permit#' .............................---............. Date ------..........---------•--•---- Septic Tank (Specify Requirements) ------ ------ ---"._...._...._.......-----..._.--........._...-•-•-----................•---....... =..:.:..- --------••-._....- Disposal Field {Specify Requirements) . -�A .. ---------------------------------------------- -. _ -. [ f (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. home 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." Signed ............Fo_t'__er*i ....... ........ . ••••--...-----...... ........ Owner IBa f�st. ........................ Title ---- .:�-.._......•--._._....._.__....-.., han owner) FOR DEPARTM94X USE ONLY APPLICATION ACCEPTED BY .. +--- -------- ---------- ••••-• DATE .... `.��..- ................ BUILDING PERMIT ISSUED --- -------- ------_---- - DATE .... -'.... . ,.__....._........ ADDITIONAL COMMENTS ....-•.............................................. ............. . .:-.._.. �V1� .:....:IL . .__.... 4��!1}'! Sia.- ------ t'".° ......... +"fir�. .. ►. `^' - `sophs .. --- - I Final Inspection by: ......................... .Date ... Dr'. .. SAN JOAQUIN LOCAL' HEALTH DISTRICT u 11 24 rn o.... r.LA Y /723M