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F(,'-V, OFFICE USE: _ APPLICATION FOR SANITATION PERMIT permit No ------------------ %----- -----'------- ------------- (Complete in Triplicate) -------- ----------------------------------- 1. p - ----- - Date Issued This Permit Ex ires I Year From Date Issued Application is hereby made to t e n Joaquin'Local Health District for a per to construct and install the work herein described, This application is made compliante with County Ordinance No. 549 and existing Rules and Regulations: f JOB ADDRESS/LOCATION ------kf�l-- -f CENSUS TRACT 2:±-�A _ - - - ---------Phone _93�'. :.----- Owner's Name - ---- --------- - ------�-------- ------------------ Address City --- ----------------------- --------- ---------------- G License Contractor's Name ________ #` � ----- Phane - cf ..--- E Installation will serve: Re idence E]Ap rtment House❑ Commercial:[Trailer Court ;❑ Motel ther ---bd _ �- ---- -- - --- k l -•- Number of living units----------- Number of bedrooms ____________Garbage Grinder --- Lot Size ____ _ ______________________ ____-- Water Supply: Public System and name A----------------------------------------------------I --- ___ ' Privatex Character of soil to a depth of 3 feet: Sand❑ Silt C] Clay Clay ❑ Pedt, Sandy Loam ,[I Clay Loam Hardpan E] Adobe Fill Material ------------ 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 seepage pit permitted if public sewer is available within 200 feet,) f/ PACKAGE TREATMENT [ ] SEPTIC TANK Size_._ �x__ r---------------------- Liquid Depth ____--�---------,----- Capacity/dZZ Type _1 "---- Material_ ,6 - ._, No.�. Compartments ___ ........... .f____-____-_Foundation ---:�,.___�__-- Pro Line ___-X___7.`.._____ .Distance to nearest: Well -----_ �� 0 p LEACHING LINE No. of Lines .---------l__ - ------ Length of each line_____/00-------------Total Length f--1 __________ �. 'D' Box -------- --- Type Filter Material _ fJ '____Depth Filter Material __,l p __---__.�------------------•.-- Distance to nearest: Well ------------------------ Foundation ------------------------ Property.-Line --`-----------i------- th r=__________ Diameter 3 �-------- Number ----------- _-_____-=-=�--- Rock Filled Yes No r)] SEEPAGE PIT ��,]. De Water Table Depth ------------------------------------------------Rock Size_ �y- Y r _____------Foundation — ---------- Pra Line --- - - --___-- Distance to nearest: Well ----------t-f1__---____-- p REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- 'Date ------•.-------.------------------ Septic Tank (Specify Requirements) -------------------------------------------------------- ------------------------------------------- ---------------------------------------- Disposal Field (Specify Requirements) ------------------------------- ---- - ------------------------- ---------------------------------------- ----------------------------------- -------------- �' i , r =. ----------------------------------------------------------------------------------------------- (Draw eAsfing 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 ---- ------------ ---- ------- fi Owner - ---- --- ----------- Title --------- - Lf---------------------------------- --------- ilf other n nwne l FOR DEPARTMENT U E .ONLY tai APPLICATION ACCEPTED BY - -------------------- ........... DATE BUILDING PERMIT ISSUED -------------------------------- -- -------DATE ADDITIONAL COMMENTS ------------- ------------------- -----!-------------------- ------------------------------------------ -•----•------- ---- -- -7-Z------------------------ -------------------------------------- ` 44 - --------------------------------------------------- -------------- ------------------------------------------------------------------------ ------ � -------- ------------ -------- _ Date -----Final Inspection by: SAN JO UIN LOCAL HEALTH DISTRICT E. H. 9 1-'6$ Rev. 5M