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FOR OFFICE USE: .PPLICATION FOR SANITATION PEN,,Ot r (Complete in Triplicate) Permit No. ---------- Date .'. --- S .._ .. _-__.. ___. .._..... This Permit Expires 1 Year From Date Issued Date Issued .....-�. ...._. V 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. 5549 and existing Rules and Regulations: r ;OB ADDRESS/LOCATION _.2 �_ ... _.._�/'�C"Z�'. ..... L�._.4.-<-_c-g-C��z.IGENSUS TRACT - Owner's Name c'cv-1r_5_ - --------1/ -✓L- .Fc2:'S------------------- -------'-----------Phone 97-6-7 ---'S-- .. Address .< _ .7.._E C/.�t T, '.�- -------��--------------_-- City _x.5z% r L �z-------- ------------ --------- Contradoi s home .o._-C' <Ca..�J� (fJ.lC f s_---_.. �I7�.L -_-License Phone Installation L Installation will serve: / Residence X'Apartment House-E] Commercial ❑Trailer Court C] Motel ❑Other. _ ----- - --------- ------------ Number of living units: Number of bedrooms _ 2_..-Garbage Grinder .... _._. Lot Size}-.- CiEKS..-.-.-._ LWater Supply: Public System and name -- ------ --. _------ -------- -------- --------- .----.-- --------.-_----------------PrivateA Character of soil to a depth of 3 feet: Sand EJ Silt❑ Clay ❑ Peat❑ Sandy Loam fl Clay Loam ❑ Hardpan ❑ Adobex Fill Material ___.-.... If yes, type _--- ---._......_____ n L (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) c NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) L // r , , PACKAGE TREATMENT [ ] SEPTIC TANK � Size_J-X�-_k//.�_____.__,__ Liquid Depth -- t%�--_-__------_. Capacity X5-oo--.. Type ._l..��- Aaterial_a,4_,C_ece No. Compartments -._Z 7------- LDistance to nearest: Well _8O... ... -....____._..Foundation _ ��./- Prop. Line ----. ----_ 0 LEACHING LINE No. of Lines .f__..___ -____ Length of each line .......... Total Length ------ C�-._.__----._ - 'D' Box ..-XType Filter Material -�Cl cam,_-_.-Depth Filter Material -_l ------_-------------. p � ------ C ` Distance to neprest: Well ._tl.....-----------_ U _ _ Foundation ._� . __. _.... Property Line --- ______________ e SEEPAGE PIT Depth ._� ._.._.._ Diameter -_91A6...... Number .--------.X._..__----- Rock,Filled Yes No C] 1 Water Table Depth ./ d._-_------_.-_---------------_Rock Size K___� --.-.-. _ _ _ ..P - s" Distance to nearest: Well __/ �>.-_-- --------------- .Foundation _lQ.�... _ Pro Line .. ------------ REPAIR/ADDITION(Prev. Sanitation Permit# -------------...___-__----------------.. Date --------- ----- ------------------ L ) Septic Tank (Specify Requirements) ----------------------- ----------------------__--- --------------- ' ---,-cy-•-�-------------------- Disposal Field (Specify Requirements) ._._ •QsrJ.J ee--...___...9`d ------ -- r r_,r..____.____.___---- - - F .............----------.._----------------------------------------------------------------------------------------- ------------------'------------------------ L -------.. .....-_......... .. ..........-.------------------------------------------- --------------------------------- -----_._---------- (Draw existing and required addition on reverse side) L 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 Phis permit is issued, 1 shall not employ any person in such manner as to become subject to Workma "ompensation laws of California." �/ Signed... .,. --- =-•/ . . ..... '-�� ---- -------------------- Owner L By -------- - - --th-an--ownwn er--)- - -------- -- ---------- Title ....... - (I other FOR DEPA ENT USE ONLY L APPLICATION ACCEPTED BY .. ,,,ems. : DATE ..�- ..'��' ___-_ .. - ------------ -----_- ------------ -- BUILDING PERMIT ISSUED .------------------ --------- ---- - -------- ----.---DATE ----- ------------------------- ADDITIONAL COMMENTS -- --- - - - - --- -- ... -- - -- - - - - - - - - -- - - Finallnspectionby �JOAQUIN -- Date L L HEALTH DISTRICT F :J O 1 'AR a.... FE•