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FOR OFFICE USE: 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 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: lI'j E`'C. ------•--_-_:_,_-------•-..'CENSUS-TRACT .. --' - -' JOB iADDRESS/LOCATION. - .----- --- --------------......... Owrier's Name ---------------------------------------------- ---- ...........___.....Phone ----9-31--3-30.2;,_._.... Stkn, Address .._..,Same_t.... ---_---------- ...... ..................... •---•-••--- City ..... .............__-................... Contractor's Mame:B ackard, _s...........••-_--..................................:.......License# ...2095J------- Phone _46.3?-7Q4,8..-...... Installation will serve: Residence❑Apartment Housed Commercial❑Trailer Court i❑ " me 1 �[Motel ❑Other.......mobil ho........._..._.._.__...,_.___-•-_--.. Number of living units:..-._7__.,. Number of bedrooms .2.`�*-Garbage Grinder ------- Lot Size .._...3__-aCre------•-....._........ Water Supply: Public,System and name ---------------------------- r' _----..........=-............................_....Private Character of soil to a depth of 3 feet. Sand'D Silt❑ Clay ❑I Peat❑ Sandy Loam fl Clay Loam Q = Hardpan Q Adobe-M Fill Material_.._........If yes,type-----------------•------••-- (Plot plan, sl;bwing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) NEW INSTALLATION:` (No septic tonk or seepage pit permitted If public sewer is available within 200 feet,) y 41 X5 a 4•"gl©`' Liquid Depth .----4�!.••--•--•-,• 's , PACKAGE TREATMENT [ ] SEPTICTANKJ.] Size _____________ ____ --,---.- i [ Capacity. ..IZ- �- Type--SS�:�_--... Material:_' in6.rateNo. Compartments :1 �, w T4s• Prap. Line 100 t._.__._.-.__ Foundation ---•-- Distance to nearest: Well .�1-1(?.:......................... , LEAGHING.LINE No. of Lines Length of each line._,...lG.�.•- .'Notal Length ,___... . '--- -•--•• " HCl: �-------------- --• r, � -- --....i � 'D' Box .1:__.._�Type Filter Material .........�" i Depth Filter Material ,.---=•-................. •••-- ts 0------------ Foundation 24+----- Property fiLine 1-0Ca Distance to nebrest: Well -_-7Q I C ' ---..._.._ Rock;Filled Yes ® No C3 .__ JSEEPAGE PIT k] Depth --- 25-t,----- Diameter ...3b-ec____._ Number ----•----- r' ` i Water Table Depth -------------90'.....,__. .._:.----.•--•-_-Rock Size .._.2............_...... .0 Distance to nearest!. Well -_____------_.1.- ©'------------:Foundation ...... Prop. Line -----•--xj(}!<------ REPAIR,/ADDIT ION(Prev. Sanitation Permit+,.................................--..._•. Date ___._._----------„-_,-•--_-_-..-•) t Septi+ Tank {Specify Requirements) ......._'4.�.244_.,ge,1.............. • -- •-.. ... - - - Disposal Field (Specify Requirements) - 4C� & 'x `t iii t--I......----..................-----•--•-------------------••--•----------------- 1. ---__-_ ---•---- ---------------------.._.. 1ld4Xlc.a- -_. �-•� - (Draw existing and required a dition on reverse side) S. I hereby certify that I have prepared�iis applion"an�7t rt+mat;tF'ie work wl �e 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 perrglt is issued, I shall not employ any person in such manner as to become subject to Workman's Compensation laws of California.” Signed o� ' «;5r ww. ...Awner � 3 Title i (If other than owner) 4 C�-61EPARTMENT USE ONLY APPLICATION ACCEPTED BY , - -f�-..•.v�' _?_..._.. DATE -: � •✓� .. BUILDING PERMIT ISSUED .......... -------- _ �'.................._=D .. ....-- ADDITIONALCOM TS------- ...... .....-•---------------------------------------------------•---.,_............,.................................r C -" ............ �................... t 1.............. _...•..__•_•__.................................. ...... Inspection by: •.._, _. .._.._Date ................. ......___------------ Final N J AQUIN LOCAL .HEALTH DISTRICT E.H. 9 1-'b8 . 5 A ,,