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,. FOR OFFICE USE:, - d APPLICATION FOR SANITATION PERMIT -------- - r C r (Complete in Triplicate) Permit No. - --- --- ------------ - -------------------- - ----------------- _ __-------------------------- This Permit Expires 1 Year From Date Issued Date issued 7 0. 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 ------ 1_i--.�_._-._, i SA_1.1016r_TA_/y-----------------------------------CENSUS TRAC16�&?_0_4�Y_/ O, Owner's Name J ' Y R- --R_. t) - ------------------- --------------- ----- Phone_ } _ -'_ _dU-- Address ----- BZ_,-fCity ---- T J]1( --------------------------------- ---- Contractor's Name __��a �G,. - C.tt = =--------License # ------------------------ Phone --------------------•------ Installation will serve: x Residence ❑ ApartmerWHouse,❑ Commercial ❑Trailer Court ;❑ ' Motel ❑ Other ( Number of living units:------t.... Number of bedrooms ___ ------Garbage Grinder Lot Size _____, _.-..---. Water Supply: Public System grid name __ - } I .--- -�.-T _ --- -�-� i G 1v ___-Private ❑ - --- Character of soil to a depth of 3 feet: Sand'❑ W_ Silt❑ . Clay ❑ -Peat E] Sandy Loam Clay Loam [:3„ ...a Hardpan ❑- Adobe Fill Material If yes, type ____________________________ ' i v'R4 (Plot plan, showing size of lot, location of.system in relation to- wells, buildings, etc. must be placed on reverse side.) f„ NEW INSTALLATION: ' (No septic tank or seepage pit permitted if public sewer is available-within MQ feet,) O PACKAGE TREATMENT' { ] SEP TIC TANK f T-N.6ize------ ------ ----°`�----------------------_-- Liquid Depth -----------' -- Capacity --------------- Type -------------------- Material----:----------------- No. Compartments -------- ........... E t �.. .�:. t '1 Distance to nearest: Well ------------------------------------FoundationProp. Line ----------�-__-._.... 1 _ LEACHING LINE { ] No. of Lines ----- Length Length of each line-----/V_0-------------- Total Length f 'D' Box Type Filter Material .5 P.TtL'_eP_e4th Filter Material ___- ____ _______________________ � p r � , Distance to nearest: Well --------�___________ Foundation ________________________ Property'Line ..______________........ SEEPAGE PIT [ ] Depth ---- -------- Diameter ---� , Number ------- -------- ___�Rock Filled Yes . No .-O IL Water Table Depth ------------------------------------------------Rock Size _1_9 i Distance to nearest: Well ---0---------------------------------Foundation -_ _n__________ Prop. Line ----------- REPAIR/ADDITION(Prev. Sanitation Permit# ____________________________________________ Date ____.._). a Septic Tank (Specify Requirements) _______________ I R Disposal Field {Specify Requirements) d------------------------------------------------------------------------------------------------ ----------------- --------------- a ZZ (Draw exi Ing and requ' ed addition on revarse side) ' yeV�� I I hereby certify that I have prepared this application and that the work will be done in accordance with San Joagqui'n` 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 which this permit is issued, I shall not employ any person in such manner as to become subject„to Workman`s Compensation laws f California.” Signed = '.'t �GXLf -r� ------ ---- Owner - a �C� BY --------- Title (If other,than owner). FOR DEPARTMENT USE ONLY s APPLICATION ACCEPTED BYj_i DATE RCS BUILDING PERMIT ISSUED -----------t------------------------ ------------------------------------------------------DATE ------------------------------------------- ADDITIONAL COMMENTS ------------'__._______ _ -------------------- ---------- - ----_------_____::_`. _-:_�- ::: :: _= ___:____:__::____:__:::::__--__-___-_____:::__.___:::_____:_-_:_______== ________:.____ ------- - -- -. -- - ------------------ - } Date.Final Inspection b i SAN JOA UIN LOCAL HEALTH DISTRICT i E. H. 9 1-'68 Rev. 5M