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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ...................... 6 - X0 C zr F _ ..... ........•----- Permit No. ...__.._.... lComple tel _ _ •.-- te in Tripfica _ Doti Issued .............................•-- �. this Permit Expires I Year From Dote Issued --w Application is hereby made to the San Joaquin local Health District for a pefmit to construct and Install the work heroin described. this application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS LO TION / - .�.1.�7.� .. -�- �cl..-.....-.-............. .-.*...:.............CENSUS TRACT ....,....�......_.. Owner's Name . ....Phone ...2937.-... 61.x. .. Address . I-:......................... ��sa�S,r-.............................. .................. 1 .. ...... Contractor's Name _. ..=a��.... ......_._1�-�-1--- ............................license �# .c�Q.�.7.� Phone Installation will serve: Residence Mlcp�artment Houses] Commercial❑Trailer Court 0 Motel ❑Other .................I........----------------• Number of living units:.....: . Number of-bedrooms .-=Garb6ge Grinder ............ Lot Sino ............... Water Supply: Public System and name .....................................----=-----....:.......................... .....:::. . _........,.......P.......private v ate Character of soil to a depth of 3 feet: Sand j] Silt❑ Clay ❑ i Peat❑ Sandy'Loam ❑ Clay Loam ❑ Hardpan Adobefll Material ............ If yes,type.........:..::............ . r, (Piot plan, showing size of lot, location of system iW'Selotion `to wells, buildings, etc. must be placed on reverse Ad NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,)' PACKAGE TREATMENT ( ] SEPTIC TANK .. 6 rT -`.._1/ - •-•---...::. liquid 7epth ...�:z l.............. Size.. .. Capacity a-QIP...:.. Type _� IGI —m"p—a / ateria ...................:: No:',Compartments - ,.............. Distance to nearest: Well _.::lOt...........` ...... .......Foundation _ ..(.0_�.......... Prop. Line . e e �.r......... LEACHING LINE No. o#`Lines -- -- --•--••-- ------- Length of each line...... a............. . Tota! Length ... ,•'D:'"i3ox � ._...' Tyne Filter Material �.lR-�.�� .De.pth .Filter Material ....3 .............. ... Distance to nearest: Well ___.10..5:....._.-_... Foundation ....... Property Line - l SEEPAGE PIT Depth .o :.--------- Diameter ________________ Number ._:`' .l:....._.......... Rock.Filled Yes'6No / f Water Table Depth ---------f -. � ......... ......Rock Size ---- --... /..!Z . -- Distance to nearest: Well .....I -.._.__ :Foundation .._....�:4. rop. Line _. �'�/........ REPAIR/ADDITION(Prev. Sanitation Permit# ...............................---..--•__-.. Date--......._....._ ._.._.( Septic Tank (Specify Requirements).---...... ---------- .................. ....... :' .....----- ...._... - ••-•-•• -- Disposal Field (Specify Requirements) _____________ . ^� ____________________---------------------- ---------- .,'-......_._............L«..:...--------------............................._....._................................ - ...............------------------...,------------------------------------------------.._--.___--._._______........-.........._.....__.____-.._ ...._.....__..__......................_...................... (Draw existing and required addition on.reverse side) z 1 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"whlch.this permit Is issued, 1 shall not employ any person in such manner as to become subject t Workman's Compensation laws of California." , Signed ---- ----------- -•-- --- ------------ ----------------------- ------ ------ Owner,Pj BYf -- -•------------------------------------•----------- xitle _....4:15!!N� �------ � I other than owner) .. FOR DOARTMENT USE ONLY t 3 APPLICATION ACCEPTED BY ---- -3---- --- -------- DATE_: :. BUILDINGPERMIT-ISSUED----------•-- ---------------------- ----------- -------------------------------.-...DATE ....---- .......__._..._..........---•..._. ADDITIONAL COMMENTS ---------- = .........................................•------------------------------------------------ ........................... • ---• --------------- ------.----------------..........• •......--------------.-............................................... .......•.........-........ . --........_. Finot Inspection by.. C- --- . . •--••-•------Date .1 ... ...�-`. ... - ......_.. ......... EH 13 .2h 1-68 Rev. 5 SAN JOAQUIN LOCAL HEALTH DISTRICT 8/7h 3M