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{ FOR OFFICE USE. APPLICATION FOR SANITATION PERMIT (Complete in Triplicate) Permit No. This Permi;Expires 1 Year From Date Issued 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: r JOB ADDRESS/LOCATION=.JIt.2. 4 3 S� 1�%l�PiP�/f�OP`'/F!�j /�O/✓� CENSUS TRACT ........(157........ Owner's Name ,o O E/P 7— 8'Cc/QGt'. y........... ........... _ ._ _.... Phone ... ... .. ....... . Address 47it 46.3 -S ......... City R/00o14/ .. . . ......................................... Contractor's Name-72X-,W.41 -52T,471e 771?VV -1..._. .License Installation will serve: Residence 12�<Portment House❑ Commercial ❑Trailer Court 0 Motel n Other # Number of living units: Number of bedrooms.........Garbage Grinder i!e Lot Size (. !! �K�. Water Supply: Public System and name _.... ......... . .. ....... ... ... ................._.. ..... ......... ....Private L . Character of soil to a depth of 3 feet: Sand Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loom U Hardpan ❑ Adobe ❑ Fill Material .ni G. . If yes,type .... . ......... ... .. (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) q i NEW INSTALLATION: (No septic tank or seepaag .. .... .......ge pit permitted if ✓ublic sewer is available within 200 feet.))/ PACKAGE TREATMENT SEPTIC _ TANK Size .. . quid Depth ............... �+ Capacity/.Z"�Type4 i .*-/rMaterial. . .. No. Compartments :;�-......... .. N Q h Distance to nearest: Well /�. ..........Foundation AQ . ......... Prop. Line ... ...0.-........... i LEACHING LINE [ ) No. of Lines s2 length of each ane 7S Total Length / Q............. (� 'D' Box v Type Filter Material 1444t ......Depth Filter Material ............................. Distance to nearest: Well . ... ..�Q.... Foundation1 _............./G . Property tine ...........-�......... SEEPAGE PIT [ j Depth Diameter ................ Numbe• .............. .. Rock Filled Yes ❑ No 0 Water Table Depth . . . ... ..................................Rock Size ................................ Distance to nearest: Wall __..........................Foundation .................... Prop. Line .......... ........_. ... Date ............._..».....) REPAIR/ADDITION(Prev. Sanitation Permit# ........ . ... ................. ......... r Septic Tank (Specify Requirements) ... ...... ................................ ....................... ..........I.......... .._................. >t .Sy.S7. ,r7................. . .(S . T. i9��,�Ei✓T / o.C.�_.. --sys>.F,•�..�9.l�P.E�oy..�Y.�.�P.�f'�J�l.... ;, ......... . . ............ .._ ... (Draw existing and required addition on reverse side) 1 hereby certify that I have prepared this application and that ♦ work will be d.-e In attendance with •an Jeoquln County Ordinances, State laws, and Rules and Regulations of • ,on Joaquin Local Health District. Home owner or dicers- + sed agents signature certifies the following: "I 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." Signed ......... Owner -�-,/ a By �. An Title �(If other twner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ( i ,r- -_ ............................... ......... ........DATE . ..7...3�-e::. b.......... ....M BUILDING PERMIT ISSUED ADDITIONALCOMMENTS� .............................................................................. ...... 1' .. . ...... .. ... ............ ...... . ............. _ ........... ... �� / Final Ins�7etf;e^'by.� Date ��S 6 E SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1•'68 Rev. 5M