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< FOR OFFICE USE: f APPLICATION FOR SANITATION PERMIT • Permit No. .X17- •-------•-----•--'"•---••----••-------•--...._.-•--•--• (Complete in Triplicate) Date Issued ----------------------------------- This Permit Expires I 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: �J• __.CENSUS TRACT -----------------------• - JOB ADDRESS/LOCATION/% �"`( ��"''` 4 / � Ed-'O ..// .•• `�. Phone y�,3-o/93............ ��G � •:T Owner's Name ------••- •................................... .:.....• -•---- ^� _.. -----. City ----- j Address .�l>.-3 s..... _ i GuP.. S 3 Contractor's Name .._ _ -- ••--•-•••- ---•- '•"--- ----- License #oz.... : .. _.... Phone .-..... l/ t Installation will serve: Residence 0, partment H use Commercial QTralle"r Court ❑ Motel ❑Other . ..... . . .................•--.....-- ��D Xao ...._.. Number of living units:.._ ... -.. Number of bedrooms ------- -•--Garbage Grinder .... ...._.. Lot Size - Private Water Supply:,Public System and name . .................. .. ... • --------• -•------ ..................................... Character of soil to a depth of 3 feet: Sand❑ Slit ElClay ❑ Peat❑ Sandy Loam a Clay Loam E3 ' Hardpan ❑ Adobe`❑—Fill fvlaterlal- -c''--if-yes:type`'-""=` (PI'ot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.l NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) 0 PACKAGE TREATMENT ( ] SEPTIC TANK' Siz ..�_fX SX• Y---•- ---•-- Liquid Depth ......��................ $a 0 T f . _. Material.&!1?�!----._. No. Compartments ... ....... Capacity .y.._.---•--••-- YPe , f ry ...._....Foundation .._02.5_-_... -- Prop. Line Distance to nearest: Well •---•---• . -G a.•.....-- ..14-Q-•- - , // // Length. of each line fD0.............. Total Length ---4P-a0............. LEACHING LINE No. of Lines ------6. ....... ', 'D' Box . C�..__. Type Filter Materials_. SAM*_.. Filter Material ....��.......................•-....... Q - ' t Pro a Line, ..5s--- -•-•--•-- •- - �D __. Foundation P rty Distance to nearest: Wel{ ' •. - t ! ................. Rock Filled Yes ❑ No ❑ - Diameter Number ._._.... SEEPAGE PIT [ j Depth •--� �f Water Table-be pth.... ... I.......--------------------------Rock Size ................................ Distance to nearest: Well _____ ________ _____ Foundation ... ........ ...... Prop. Line ...................... _ REPAIR/ADDITION(Prev. Sanitation Permit# •... ••• -- ............... Date -_--••-- ---------------- Septic Tank (Specify Requirements} - -----------------• ------------------- A Disposal Field (Specify Requirements) ......'.-•--- •-••--•-- ----•••... .... t . } ....I... •-•--•-••-•------• ..... ...... l 4 e r-.r........__ ....___ ....-•.......... . ..... . ........... ... . ;�.._..... �• •..-r��tlDrow existing and-required-addition onsevers�,si a�.•��—�-�—• .��... -- �Thereby certify that I have prepared this application and that the work will be,.done in.accordonce wifh.Son Joaquin r`County Ordinances, State Laws, and Rules and Regulations of the San Joaquin 1 h l•Health District. Home owner or licen- sed agents signature certifies the fdlloMring- 'ts - • "I certify that in the performance of the work for which this permit is issued, I shall not employ any personuch manner as to become subject toWorkman's Compensation laws of California, _._. Signed .... ....._.-••• -- .Owner • .... Title _ . ................ _ .... By ........ •-••----- -- • -• - (If other than owner) FOR DEPARTMENT USE ONLY • .; APPLICATION ACCEPTED BY -----• --•-•----• ......... = ............. -•-------- --------- -------•,DATE_._- ----- BUILDING --- 1 ................. ...... . -------------------- ..............._._ BUILDING PERMIT ISSUED .... ADDITIONAL COMMENTS - --------- ------- --•--- ---- ---- .- ------- ---- --- •-• ------------ ------- Final ....... - - t:._- - -- - •- -------- ------- Date---- !G•� �•.-. -- -- - - -- -- - ------ - v Finallnspe :o SAN JOA0.bIN LOCAL HEALTH -DISTRICT E. H. 9 1-'68 Rev. 5M f