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FOR oFl=1cE usE°:� y - .. ' ' A PLICATION FOR ,SANITATION PERMIT - ------ ------------------------------ ------- t.< ., Permit Na. . r�0�_7 ' (Complete in Triplicate) _. i Date Issued ---------------- 1 This Permit Expires -1 Year From Date Issued' - --------- Application is hereby made to the San Joaquin Local Health..District for a permit ^�ok construct and install the work herein described. This application is made-in compliance with County Ordinance No. 5,49 and existing Rules-and Regulations: B ADDRESS/LOCATION .--- `L�� ' ---------- ------ eSC.--..,-'..CENSUS TRACT --------------- -------- y___.Owner's Name - .'.� 1T�" = = Ph e 5 �� ^'7` *�� ----.Cit e5G1 - Q!�I Address ------= 5 7 JQNS - - - Y ----- --------------- + ,. - -- -� ----,�- � - mmercial :e Trail'- ----------------- Phone ---- ---------------------- Contractor's Name --- Q-VI/11� � = ---- 1 ----- - = - s # --- Installation Will serve. Residence iApartmnt Nouse❑ Co ❑ er Court 0 MotelOther -_- ' ---------------- / Number of living units:____________ Number of bedrooms . __Garbage Grinder J_ lot Size -.- 1_a x_____ 1______..... Water Supply: Public System and name ------------------------- -------•-----=----------------------------------:------•----- - Private'[ Character of soil to a depth of 3 feet: Sand'❑ Silt:E]-" ' Clay El Peat❑ Sanyj Cacrm"LeJZ Clay Loam,[] i Hardpan E] Adobe ❑ Fill.Material IJf Ef +#s;typl-i ----------- --- (Piot plan, showing size of lot, location of system in relation to wells, buildings' etc. must be place'e on reverse side.) 4 NEW INSTALLATION: ' (No septic Itank or seeps it ermitted if'Public sewer is al€ilable within 20011feet.j _ G Size-57 x '-------------- Liquid De��th,!_-`7 '------- t PACKAGE TREATNIENT3'ti[J] SEPTIC/TANK'{ r-. z. t�" �✓' -apacity�.L� ------ype� F _�Material_cQN _ No. Compartments ------.�-..___.._- �� T e _ _ ..�: " ,,r istance to nearest: Well r_____ __�_x_�_+_Foundation !lam ____ __________.Prop. Line ___________.__.______ LEACHING LINE [ No of Lines ------r2------------- Length of each line_ Q_�___�._____ Total Lengfh D' Box pe Filter Materr:l �__ Q5�6eptii'-Filter Material ------- ------._ _______•.__.___-•- t i , J Distance.to nearest:WWII _!--__5D___, ---- Foundation ��___________________ Property Line ___________________.___. `SEEPAGE PIT De th ------ Diameter _______________ -Number ________ �:___�_________ Rock Filled Yes ❑ No [ l p :,* n - T-. v -4- -------------- 4- ^} �J - 1Q ---------Rock Size---------------------- ---•---- �, Water Table Dep h - - = 1 � ----------• .1. Distance to nes st We'11��t`tJ -__-- _-,-�' -----Foundation _'------------------- Pro . Line ---------------------- Previ- REPAIR/ADDITION{ . Sanitafion�ermrfi# _�--- -----------------------�__-_ Date ----------z -_-------------------1 Septic Tank [Specify Require 'ents) Y - _______________ -If '__ __________________ ify R' ' I -----= Disposal Field--(specify Requirements) -------------------- -- � =c--------------- -: 3 - - --- J----------- ; --------------------------------------------- .1 -`` .- _ r (Draw existing and required addition or_ reverse siae) I hereby certify that I have ptepared this application and that the work will be•done-,n—accordan±cewwith San Joaquin ' County Ordinances, State ,Law's, and Rules and Regulations of the. San Joaquin Local HealtI0156trict.,Home owner or licen- sed agents signature certifies the following: t E "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 becomeject to Win 's , ompensation laws of California." Signed - k_i = = Owner ;4 t-�-V )L'1-=I By -----------fi ------------------------ 7 --�(1--- . - Title ' t T° ---'--`-` --- ------- -------------------------- - (If other than owner). M/A - FOR DEPARTMENT USE ONLY r APPLICATION ACCEPTED BY ----------1-r5-'-0------------------------------------ ---------------- - ----- DATE --- J L - -------------------- --- PERMIT ISSUED -- --------------------------- - ---- -----------DATE ----------•------- ---------------------------------------.-.---..--..--.-.--.-.-—�..----.--.-.--.----.--.-.-------.--.-.---_.-.--.-.---.--.---.---.---.- --- ' . .. AIrITIONAL COMMENTS�--�.. —_ fir- - ----------- ----- - - -------------- ---- fll _ ' _ ., _ _ --- --- f Final Insp b ------------ ---- =-------------..Date You k: •- SAN JOAQUIN LOCAL HEALTH .DISTRICT ' E.-H. 9 1,-'68.Rev. 5M. �