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FOR OF9CE-USS: APPLICATION FOR SANITATION PERMIT =----------------- -- ---------------- Permit No: (Complete in Triplicate) Date Issued ,) --------------------------------------------------------- This Permit Expires 1 Year From Date Issued Application is hereby made to the Son Joaquin Local Health District for a permit to construct and install the work herein 4 described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations. lI JOB ADDRESS/'LOCATION --- -� 1 p ------1`iW/---y-----� -p------------- c'�C' ------CENSUS TRACT -------------- --=-------- Owner's Name ----------- ---- �-•---------------------------------- - ---------Phone ------------- -- --------------•---- Address -----::?01_5171----l -- -.f�_W. - Lel-------------- -------- city : S_C__I=--t_Q--- ----------------------------------------------- Contractor's Name -Cabs----._y,�Q�E`R_N ------License # !MN-2- Phone ------------------------=----- Installation will serve: t Residence fAApart�House,❑ Commercial ❑Trailer Court i❑ _ Motel ❑Other -------------------------------------------- r # Number of living units ---- Number of bedrooms 3--------Garbage Grinder Ad_V... Lot Size --- 4�_RKA-6�-________--_ Water Supply: Public System and name ------------ - �x----------------------------------------- ---------------------------------------'--------Private Character of soil to a depth of 3 feet: Sand'❑ SON[] Clay E] Peat F1 Sandy Loam ,n- Clay Loam :❑ ._ . -�-��-� Hardpan❑" Adobes-❑ -Fill Material"- +��-�!f yes,-type �-� -��---- : ' - (Plot plan, showing size of lot, location of system in relation to wells, buildings etc. must be placedr on reverse side.) tr' NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewler4s available within 20.0;feet,) PACKAGE: TREATMENT l ] SEPTIC_ TANK[ ] I�Up, ize_- a ____TX I .X Ste- Liquid Dep hi. --- -e.__.___-. �. Capacity_______ Type __ _: Material-, On( VT 1No. Compartments ......�__--____-- \ Distance to nearest: Well _50--------------------- '_.Foundation =R___________ Prop: Line ---- ' Q Total Length, t_- Q LEACHING LINE No. of Lines _____ ____ ______ Len-gth of each line_.. - -- g ------••- 'D' Box .---- Type Filter Materiarft<—A__--.Depth. Filter Material ---_ --------------------------•--- -. I Well------.---- __ Foundation __________.l -I___ Property Line _________-,______________ SEEPAGE PIT { ) Depth Distance to I nearest: Diameter _ . ._ Nlber .-_________---------------- Rock Filledti Yes ❑ No C]: V., :q , ,- WZ. ater Table Depth------ _. -..,r --- --Rock Size ----.---"-- ;--, ------------- ) ----- Foundatifib"r.-------- Prod Line ----------------- Well=_----'--------------- -- � ,P- REPAIRfADD1T[ON{Prev. Sanitation Permit# j � -- -- ------- -- -- Date ---- ------------�-------------) Septic Tank (Specify Requirements) ------- ------)-----------------=--------------- ---------------------------- s • ------- ------ ------ . Disposal 'Field {Specify Requirements) i�.---.- ON--�--�- , 5OS ---------------- C �`4� -----F� _ '--:._. tN s �� _-tom _ ---------- 1 - -•f_ - ---- ---- - -...`.,...(=Draw.existinb-and:4requtredEadd.it*h.-on-reve"s'e=sidel.:.� 1 I hereby certify that I have prepared this application and that'the .work will Abe done 6� accordanc4-,,vri1h San Joaquin County Ordinances, State Laws, and Rules and RegulatiosF'af the San"Joaquin7lLocal Health District. Home owner or licen- sed agents signature certifies the following. 9 - "I certify that in the perfWrma" ce-Wthe work--for whech thrs.p.ermit-isAss� , 1 shall not employ any person in such manner as to be c a ubject t rkman's Co pensation laws of California." ! { 1 Signed Ct: Owner - Tit a -- n_= (!f other than owner) � ••- ( FOR DEPARTMENT USE ONLY i APPLICATION ACCEPTED BY --------- 1--R,- '-----:---------------------- --------------- -------- DATE ��=. 1 BUILDING-PERMH ISSUED --- -- - --- - -- ----------- ATE`�-`�-�''-=--------'-"-,-�_'"-_ ---- ADDITIONAL COMMENTS __ _ _____ '_ -------------------x t ----------- ---------- - - -------- - _ ___________________________________ - ------------ �..._....�.�._ -- -� _____________ _ ------------ - ------ _____ ______ _ ___ _-__________._ _ _�_ __ ___ ---- - _ _ --- _ ___ __ __ ____`_____________ ______ - _-- ___________-__- -------------------- --- -- __. ----------- -- Final InspeZtion by. = Date -` ~. SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M