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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: JOB ADDRESS/LOCATION 14:--- --------__-___R _---- -_ -- CENSUS TRACT ------ Owner's Name —me .I a ---- � _-RANCH Cf� - _ I Phone _ 9------------------ 3 �5 Address _.1--1qK�'-L/ ------F.----.R17�E�-------RD----------- ----------- --- City ��/� - -----------------------•-----•--•------------•------ Contractor's Name ._0j4J E�-------------------------------------------------------------License # ----------------------- Phone _............................. Installation will serve: Residence)<Apartment Housef❑ Commercial ❑Trailer Court !❑ Motel ❑ Other --------------- ------- __----------- Number of living units:-. .- _.__ Number of bedrooms _� _Garbage Grinder """"""��1��1�__ Lot Size _ CRE6.6 -------- Water Supply: Public System and name ------------------------------------------------------------------------------------------------- ------------Private Character of soil to a depth of 3 feet: Sand D Silt❑ Clay ❑ Peat❑ Sandy Loa MA Clay Loam ❑ Hardpan ❑ Adobe ❑ Fill Material .1-1f_U If yes, type ___________ _________-___ --_ IN. (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) '4V NEW INSTALLATION: (No septic tank or seepag it permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK'[ ] Size-----------____---------- __ -.__.. .. .... Liquid Depth ________-_______-____.-.- 4 Capacity - ----- TYPE ----- ----- Material--- ----- No. Compartments ----------------•----- Distance to nearest: Well .- - ----__-----------------------Foundation __ ------- ...... _ Prop. Line ---------_----------- LEACHING _.-_-_____--_____LEACHING LINE [ ] No. of Lines _- ---.---.-- _ Length of each line - . .___ .. _ --- otal Length ---------------------------- 'D' ________-_.__.___..__._'D' Box -- Type Filter Material --------------------Depth Filter Mate ial --_ ________---_..__............. Distance to nearest: Well _. --------------------- Foundation ..---_--___ .-_-___ Property Line --_____._-_____--___ SEEPAGE PIT [ j Depth Diam er ------------------- Number -------------------------- Rock Filled Yes ❑ No ❑ Water Table Depth :___ --- ----------------- Rock Size ----------- ---------------- Distance to nearest: Well __ ---------------------------- ------Foundation __._-_ ____ Prop. Line ---------------------- REPAIR/ADDITION(Prev. Sanitation Permit# __.-______________________________________ Date - - _ -- . ___.____-_ __•.__-___.__.____.___ � AA - ) . (�ASe tic Tank (Specify Requirements) ----- rs--�Qx------------------ - -- 0 ------ 1, W Disposal Field (Specify Requirements) .___X-EPCH__-__r1VIE______Ab-Ptrt----- ` G_ - - ---- ---- --- --------------------------------- (Draw existing and required addition on reverse side) 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 certif t t in the perfor ce f the work for which this permit is issued, I shall not employ any person in such manner as to bec a subject to W rk 's Compensation laws of California." Sign - -----------. Owner BY --- -- ---------------------------- - Title - ---------------------------- - -------------------- ---------- (If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--------�1_R'0--------------------------------------------------------------------------- DATE -------- BUILDING PERMIT ISSUED ------- ----------------- ------------------------------DATE -------------------•--------•-•--••---•---- ADDITIONAL COMMENTS _ - - -------- - - ----------------- --------------- - -- -------•---•--:•-----•=-------------------------------•-------------------••----------- --- ------------------------•-------•-•--•---- - ------- -- ------------------ ------ -----------------•--------------------••-------•- ------------------------------•-------- ---------•-------- ------ - ------------------------- ---- ----- --------•------------•-•-------------------_---------•-- -- -------------------------------- ------------------•------------- ----- --- ----:_::: -- -- -- = -- ------------------------------------------ __Final Inspe • n by: -----------Date -- --_7 _:____:------- Final SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M