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t� -IC-teE USE; SE: APPLICATION FOR SANITATION PERMIT Permit No:• 7 �------- (complete in Triplicate) � Date Issued ..3/> /Z This Permit Expiros 7 Year From Date ssu Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein ith County Ordinance No. 549 and existing Rules and Regulations: described. This application is made in compliance wJ L lrt/ 5\ A--------- - - -----.CENSUS TRACT JOB ADDRESS/LOCATION _...9 - �---- - - "--'----. . .Phone _.3.(eY"'---�4't.'�,5� Owner's Name �r R-------- ------- - . Address .-------g-0-3-A ...(?-t.1. Titr- - - - - s� Phone 537..-? d•• Contractor's Name ... .o-u..G- _C}S---S- •.- .1..1G••. t4.N.K.`'------.Litenae tf' •---------------'- Installation will serve: Residence[Apartment House fl Commercial ❑Trailer Court j] Motel ❑Other ------------------ Number of living units:....1..... Number of bedrooms .__..:.Garbage Grinder -_.._ ---- Lot Size ----��'---'- private [Ly' ` `---------'--- Water Supply: Public System and name -....----------------•--- Clay Loam [] Character of soil to a depth of 3 feet: Sand]] Silt❑ Clay ❑ Peat❑ Sandy Loam 0 Y Hardpan [r 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,) ii PACKAGE TREATMENT [ ] SEPTIC TANK tk- Size.,_.5_es m;;!_.?..�-------------- Liquid Depth --=1-� -------• l Capacity J.1600----. Type -Pr-s-'SA51 Material.. onl.k-K'&Te No. Compartments ---Z-�•----•••- Distance to nearest: Well -------.1.y-Q.. ...... .......Foundation ...1_4�.......--- Prop. Line....70------------ Distance �----•---- LEACHING LINE I ] No. of Lines -__�r----- ------- Length of each line._k14 .O!_....... Total Length -_-'a.-. . 'D' Box - 4.5.. Type Filter Material&,Prt5--.� epth Filter Material .....r----- --- ---- -�0--....•---- Distance to nearest: Well ...C _Q.�......... Foundation -- 1 0-_.---------._ Property Line rr d No ❑ SEEPAGE PIT [ ] Depth �...._..__ Diameter ...c�l�...... Number ........?--'- ......---- Rock Filled Yes [ Water Table Depth Rock Size _...1- --y�...... Pro � Distance to nearest: Well ---------IVA---........-------••.Foundation --.-L4...------ Prop. Line REPAIR/ADDITION(Prev. Sanitation Permit# . ... .......... Date ".................-'-- -) fy 9 ----------- -------------------------- _ - _. -- -•••--•------•------.........__..•..-•••-- ----- Septic Tank (Specify Requirements) -'=-----..._- Disposal Field (Specify Requirements) --------- .. ----------------- --------............. ........ .... . .... .-exi--------"--re--uire-'-add..tIo - ' (Draw existing and required addition on reverse si e I hereby certify that I have prepared this appllcaNan and that the work will be done In accordance with San Joaquin County Ordinances, State Laws, and Rules and Regulations of the San Joaquin fecal Health District. Home owner or licen- sed agents signature certifies the following: "1 certify that in the performance of the work for which this permit is issued, 1 shall not employ any person in such manner as to become subject to Workman's Compensation laws of California." oy.G__-.Rs 1 - ._1..4.G...._.Sf!•W_-K----------------. Owner ....-. Sig ed -Q--- - ... . - Title -�`/ .. (If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY .-f .............. .. ---- .. DATE .. - .................................... DATE --------------------- --------- BUILDINGPERMIT ISSUED -----'--'--'--'.............'--------....---------- ....---'---'-'-'-^----------._---...._. ADDITIONAL COMMENTS ---------------------------'------ - -- -------_--..._---- ---------- ---- .-.... --------------------------...------------------ -- ---------......................................................... .....-"" -- -"- --' -"-....-_---•.. "--'--'.... .. ....... --.._........... . ....................................'- ---- -- - ---- .................. - _ _______________ ___ ______ _ _ j '- - ------.Date ----'Y _ ... ...------ Final Inspection by: . - - ' - - - --'---- -----.... SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1268 Rev. 5M