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FOR OFFICE L15E: - � APPLICATION FOR SANITATION PERMIT ..................................................._..._. (Compiete in Triplicate) Permit No. _--.. .._ .-...7 :..................................................... _�G —7 This Permit Date Issued .. .........•-----•------------------- � Expires 1 Year From Date Issued � ............... f Application is hereby made to the-San Joaquin Local Health District for a per to construct and instutl the work herein described. This application 'is made in compliance with County Ordinance No. 544, and existing Rules cindliegulations: R 108 ADDRESS/LOCATION �� 9. .-.._ --__.f"1. _PON ._...J •�.._..°........CENSUS TRAC4 ...... Owner's Name ............. .�C'I R 11f. F' ,I 1- ••---...,...... -•---.........._.....Phone .........j _- ---•- ........ h. �I pp -P .,A ..............................................M Address ... / 77. 1 City ..... .._. I`F Contractors Name 6.W .947k-.................:..._..-•---------•---•-••--•-------..........License # ....................... Phone ........................... t R ' t Installation will serve: Residence ❑Apartment House❑ Commercial,❑Trailer Court I Motel ❑Other _ I Number of Living units ..... Number of bedroom's ::__:')Garbage Grinder �� Lot Size...: R.E .r-r'` ..•..•••• ? Water Supply: Public System and name .................................... . --------------................... '..... ._!:__._._.___...._Private rna�ctTof sal to a depth of_3 feet: Sand -eat..❑.:, Silt❑ Clay .�P ❑, Sar}dy. Loam ,. Clay Loam-❑,,�;_,,�� .r _--�------._Hardpan�❑ _Adobe-'❑1=F_i`l Materia} _ I�„ If yes,type ; =- (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, it permitted if, public se eir is avoil ble within 200 feet,)i .V PACKAGE TREATMENT SEPTIC TANK.[ j Size...:. .................................... -----Liquid Depth _................--------- j ..... Capacity _.�................ Type ....-----------------Material -...•.r.------------.-- a. Compartments ................. i Distance to-nearest: Well --------------------'_._............Foundation -_--_- ............... Prop. Line ...................... ' LEACHING LINE [•j No. of Lines ..__---____._ g � - �� i i ___:--... . Length of each line-----•-•------'---_._._. Total Length ...........:.:............... 'D' Box --- ------- Type Filter Material - ...............N ._Depth Filter M terial .... ------- -_--_---•----•.--. (� \ � Distance to nearest: Well _' . ......... . .......... Foundation •._..z_..:`... ----- Property Lineinn ._.............. i � I � SEEPAGE PIT.., I ) Depth ------i------....... Diameter ................ Number _...-............... ..... Rock Filled Yes ❑ No ❑ Water Table Depth`- Rock;S ize` I.' #,1 _ ,=1• i - ._ - . { { { •) �.,_.._Distance...ta_nearest:_Well .. ............•---••----••-•�----•-Foundation .... . ......•_._... Prop Line ---•--•----. ......... i REPAIR ADD / (TION(Prev. Sanitation Permit# .......... _ Date ----•-• ••-----.....-- } Septic Tank jSpecify Requirements) % ^ ----------- M n:= =r.` -• .. ............................ , ............................ Disposal Field (� �.....-,� iI>,•ti•�"y:-:�� t • 'f-- - Specify Requirements) ._._ 1� ..:�... _-... _......w/.�- .. _ . ._ ............ .. .... --•- -----------•--•-- -........ ...'"F'." t -i---_ .—(Draw-existing_and.required_addit pn on_rhverse side) l i . I hereby certify; that I have prepared this application and that the work will, be done in accordance with San Joaquin j"CountyOrdinances, 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 e e rformance oft ark for which=t1+is permit is issued, I shall not employ any person in such manner as to bec a sub)ec o Work an's. ensation laws of California." } io --� ,�..... = . ........ Owner t } BY • ..................... :....:...........................................••-•-= -7-AQ, xitie ................................................ ....................... (If other than owner) 1I FOR DEPARTMENT USE ONLY A ! APPLICATION ACCEPTED BY .......(.:.t. .:. k..........................................•---••---•------------' - . DATE '..! -a� f BUILDING PERMIT ISSUED ....................:......... .•------------ .....................I—...................:."...... DATE =.. :. # ADDITIONAL COMMENTS _ - �^ _.. _ ...:':................................... ........... ................. _ __. ..._. _.._.... ......._._.._...................... F ^ __ _ _ _ __ ___ _ � r_s�, ?l ��i '':4`-� .._... ............... :. .......::..................................... ._ ..• _ ................................... ..... .. Finallnspec i_, .� -- --- -.- - -- <_ _ Date , c. SAN JOAQUIN LOCAL HEALTH DISTRICT F w 13 241.'A;t Vow 5M 7/723-14