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FOR OFFICE USE: — ft - . APPLICATION FOR` SANITATION PERMIT ------------- - - Permit No. (Complete in Triplicate) --------'_--.?____-A----------------- ------ n-. Date Issued -"-- - ---....- . --------------------=---- This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local HealthDistrictfor a permit to construct and install the work herein described. This application is made in compliance with County OrdinancenNo.•549 and existing Rules and Regulations: JOB ADDRESS/LOGATI N . -/- � .- 11'I L --------RIP a� CENSUS TRACT --. � - - Owner's Name ---- - AM_F—S------_Tbt.SJ_/Se7N_>------------------------------------ -------------------Phone --------------------------------- Address -----�0� I---- A� OL City --- l--�Q Contractor's Namee� ------.License # --------------- -------- Phone ------- Installation will serve: Residence partment House,[] Commercial :❑Trailer Court ;❑ Motel ❑ Other ------ ------- Number of living units*__: --- Number of bedrooms -3------Garbage Grinder Y.5 Lot Size A4 RIF9OF..---•-----•-• .Water Supply: Public System and name Private I �••-+ticter of soil to a depth of 3 feet: Sand Silt Clay ❑ Peat❑ Sandy Loam.•❑. Clay Loam ❑ i ia`4 ; . ardpon ❑ Adobe,F Fill Material Ahz__ If yes, type -------------------------- JA .(Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) NEW INSTALLATION: INo septic tank or seepage pit permitted if public sewer is available within 240 feet,) PACKAGE TREATMENT f ] SEPTIC TANK f J Size-----------------------------------•----------- Liquid Depth -- ------------------.---- (� a„"Capac�:, ----------------- Type-- -�-------------- MaT+�`i�1"`_---'.��--------- No. Compartments -----------------:: :.. Distance to nearest:.,Well ____r'~ -- ---------- --------Foundatlon ---------------------- Prop. Line --- ------- Q LEACHING LINE [ ] No. of Lines - -_----- ---=----•--_-_Length of each Eine-------------- ------------- Total Length ------------------.•--------- D Box .-----.--- - Type Filter Material --------------------Depth Filter Materia! --__-__-_____-_----_-_------------,-- ...... Distance to nearest: Well ------------------------ Foundation -____--.-. --- Property Line SEEPAGE PIT [ ] € Depth ------------------- Diameter ---- --- Number ----------- ---------------- Rock Filled Yes E] No 0 Water Table Depth ____ I Rock Size ------------------------------- Distance to nearest: Well; r ;�--" ------------------ -----------Foundation ----"-�..;�__}--------------------------------- Prop. Line ---------------------- r'�= ---- Date,. "'%'` REPAIR/ADDITION(Prev. Sanitation Permit# _.._-- -N: - ;_-- _j-¢--- - - - ,�------------------------ b—_--609( ----------------- w n� N� Septic Tank (Specify Requirements) -.fly T� _ f 1L--,rGO----- `- ,�3 - 1�-t3----:T 1lJ --,---------XT---Z`�. Disposal Field [5 7 �� : p pecify Requirements) �-(.ST/ ^�. `!_��3L'. �, 1-n(GL ` COM ?f1-RT/✓I_EfV`'r----CT�KC>Z, R I.. 1�4 ------ -r_1-1_-,..--Ec. x -9P1G_ _:_P+T-__'ro S. P��:E_M �t' � xl_sT�=►N�= A�H_ � . == == =� (Draw existing and required addition 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 "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 bec u to W an's Compensation laws of California. Signed = Owner By ------------------------------------------- --------------------------' i Title (If other than owner) _ FOR .DEPARTMENT USE ONLY APPLICATION ACCEPTED BY E-R- ------ �1 - ----. DATE 6 BUILDING PERMIT ISSUED -----=------ -------DATE ------------ ----------- �_ - ADDITIONAL COMMENT5 ---- -------------- ---------=-------- - ------------------------------- ------------------------------- --------------------------------r�-------------------------------------- ------------ -------------- _ __ Date J_`f-,/_ - _ ----- -- --- - Finallns n SAN JOAQUIN LOCAL HEALTH DISTRICT C E. H. 9 1-'68 Rev. 5M