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w r 7 FOR`OFFICE'USE: APPLICATION FOR SANITATION PERMIT tr -----------t:--------- --------------------------------- (Complete in Triplicate) Permit No. This Permit Expires 1 Year From Date Issued Date Issued -_Z --------------------------------------------------------- Application is hereby made to the San Joaquin Local Health District for a per to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: /q JOB ADDRESS/LOCATION --f_ --�-� -----------------/MRS-01-b-------------------------CENSUS TRACT --- =--Z/-.------- Owner's Name�------------y __ #----- F ERS------------ Phone.___:_: rr Address `__/__ ,?��-------Is---- .-1`{ _ _ C L- ---------== -----. City �C�'--- , . ' ------------------------------ - Contractor's Name _OWN-E-R---------------- - ------------------------------.:.p--------License # ----------------------- Phone '--------•------------------ Installation will serve: Residence ❑Apartment House❑.Commercial ❑Trailer Q@VR ,. . Motel ❑ Other ------------------------f- =-------------- Number of living units:---- ------ Number}of bedrooms _ F __Garbage-Grinder 40---- Lot Size ACRJEiA �_-----------• Water Supply: Public System and name 7------------------------------------------------------------------------------------------ 3----'--------Private gi__� Character of soil t�ora depth of 3 feet: Sand❑ Silt❑ E] Peat Peat❑ Sandy_ Loam 0, C icy Loam RFS _- -� �. Hardpan obe ❑ Fill Material _ _ __ If yes, type ______.--_____ ---Y-_______ i {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,) it yA9ly w PACKAGE%TRLATMENT [ SEPTIC TANK J� Size______ !!------------------------------_____ Liquid Depth ____��________-_-- G Capacity 127.QO----- Type PREFAB material609-LI----- No.l Compartments __1Z_1__ ....... �} istance to nearest: Well ------ C�___ ___________Foundation -_1�-_"'}' p. Line -___�--�----_ l ---- -_I---- Length of each line----- _`_7� Tota! Length LEACHING LINE No. of Lines k g ------------------------- X/ vD 'D' Box�ES_ Type Filter Material RGc/�____Depth Filter Material. -----�,/________ ________________________ Distance to nearest: Well ___5 r ____,Foundation ___Ji�__r7-_____ Property Line __, _�`}__._.... SEEPAGE PIT V?-"" Depth /1Z__,-____ Diameter Number Number -____ -________ Rock Fil ed Yeses-- fo C1 Water Table Depth ---- 44, ---r-----------------------•....Rock Size K Distance to nearest: Well ----A� ------------------------__Foundation ------ Prop. Line _--------..__ REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date ____--______-______________--_____} Septic Tank (Specify Requirements) -------- ------------------------- ------------------------------------------------�_ ---------------------,-- • -_ --------f-----•--•------- Disposal Field (Specify Requirements) --------------------------=-------------------------- ------ -----------=---------:------------------ ------- w ex- ----- ---- - ------- -------- --------------------------- (Draw existing and required-adtion 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 certify th o e of w rk or which this permit is issued, I shall not employ any person in such manner z as to bec s ject to an's laws of California." Signed - ----------------------------- -- --- ------------------------------------- Owner j BY ------------------------------------------------------------------------------------rjR—& Title ---- --------------------------- ---------- ----------------------- (if other than owner) �-�-p FOR DEPARTMENT USE ONLY l APPLICATION ACCEPTED BY ----- TTIR ©---------------------------------•---------------------------------------- DATE ---- ------ BUILDING --~ � . BUILDINGPERMIT ISSUED ------------------------- --------- ---------------------------------------------------------------------DATE _..__.------------------- -- - -------ADDITIONAL COMMENTS - - .. _. -. - - - - - - - - - _ - , e --------- ---------------- ------- ------------- ----- - ------ ---------------------- - T ------------------ ----- --- -- ---------------------. -- - -- -- - - - ------------- -------------- - -- -------------------------------------- ------------ Y- Final Inspec i ' -------------------------------------Date -r ------ SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M gib,