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FOR OFFICE USE: — APPLICATION FOR SANITATION PERMIT �2d l/ ,_ -----'� -- -------- "�------- __�_�--1S- -- {Complete in Triplicate} Permit No: _/ --------------------------- J------------ This Permit Expires 1 Year From Date Issued i Date Issued _ � ?�. ------- - -- 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 madeinc1o�mplian 'w,i h ountoOrd/inna'nce� No. 549 and existing Rules and Regulations: 7�U J Com- I -CENSUS TRACT -----/- --------- JOB ADDRESS/LOCATsION __ __ _ _ _ ! I Owner's Name!/(lYW - '` ------------.----- --- �_ _�F Phone d IF Address ------------------ ---- - ----f- --------- -- -- - ----------- -------------------- City �//` p �7 Contractor's Name ---- - ___----- - --- - --- ----------•----------License #I _ I�------ Phone _—V- -"_l__�#__-!_ Installation will serve: Residence Apartment House ❑ Commercial:❑Trailer Court i❑ Motel ❑ A/ � Other ----------- --------------------- umber of bedrooms ____��GarbagGrNumber of living units: .____.___ Lo ______________a____X i Water Supply: Public System and name r - Private ❑ , Character of soil to a diepth of 3 feet: Sand'[- `Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ i Hardpan Adobe Fill Material ------------ If yes, type ___________________________ i (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) }A p ", epage pit permitted if public sewer is allable within 200 feet,J �� NEW INSTALLATION: (No se tic�,tank ori. PACKAGE TREATMENT SEPTIC TANK Size______--€__ __ ------- /I Liquid Depth _�y____..._,____. [ 7 V , ie", I Capacity 1d Type !-.`___ __ _______ Material _�__ .No. Compartments __--y ._._.__. Distance to nearest: Well ,__" ______ ______ _____'Foundation t/!1_�7`._____ Prop, Line ._ _._._._ LEACHING LINE: [ No, of Lines �______�•e________-�`_i_ t`e_AJth of each (line--------�.______€------- Total Length ---�10---------_-_--- V40%, ..-_--- F 40 '1 1 4f I.�KSA p I/ 'D' Box ..._p "_ Type._F'iltery�Maferial -:� ..----Depth Filtert4m aterial ------/_c?_________________________ Distance to nearest?Well _____�" _ f___ Four►dation.�/4____ ----_.__ Property Line -- -_._.___ `P' ,� ; / SEEPAGE PIT [ ] Depth Ir9------------ tDlam�er!Y_.-W_______ Number ------,�-------I__.___ Rock Filled Yes No p Water Table Depth }-----------)V----------------------------Rock Size -11r 11,4-144-11/ �i4 341 f � f Distance to nearest: Well --------1--------------_----------------Foundation i/L4__'I" Prop. Line --A�__--_---.---__ REPAIR/ADDITION(Prev. Sanitation Permit# --------------I------ ------ Date ____________ _____.--------------J Septic Tank (Specify Requirements)_!----- --- ---- Dispose) Field (Specify R uirem nts) --- ------- ------------------------------�---------------------- ------------------------------------F------ f ---- ---- - ------ --- ------ 1 ----------F---------- -_ ------ --------- - . --- --- -- ---------- ------------------------------------------- (Draw ezisting',aridlrequired addition on r ri�:d ) 1 hereby certify that I. have prepared this application and thof the work will �>beadone in accordance with San Joaquin County Ordinances, State Laws, and 'Rules and Regulations of the. San JoaquiniLocal 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 Y�tan ------------------------ Owner ~ Title By ----- -- -------- --'-(lf of owner} F PART MENT USE ONLY A+ APPLICATION ACCEPTED BY _____ -------------------------------------------- DATE _ '-33 ----------------- ---------------------------------------- BUILDING PERMIT ISSUED ------ - --- ---------------------------------------------- E--------DATE ---------- ----------------------------- ADDITIONALCOMMENTS ---------------- ------------------------------------------------------------------ --------------------=--------------------------- R ----------- - ---- ----------------------______E___________ ___ _ _ ____-_-- __ ________------_ry:________--------______-_______.__ _ ___-_-----------------------------____________-___ _ ------------------------_----------______ _ _ ____ __ ___________ __ _______.__ Date ---3--`.2y/ --------------- Final Inspection by: ------ --- - -- - -- - �`..'-------"= tJ - ,fit � s t AQUIN"-LOCAL""HEALTH DISTRICT E. H. 9 1-'b$ ev. 5M