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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT �j ------------------------------ --------- Permit Na. - ----- ------------- ------------ {Complete in Triplicate] r� ------------------------------- ----------------------- Date Issued _4215_/ --------------------------------------------------------- This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaq'uin 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 C v --------SO----------------CENSUS TRACT --- �` -----7-Fbw-- -----------DVtirR$--•--•--------------------------------- -- ---- - ------- Owner's Name - - - - Phone ------------------------------------ of Address ----------- - - 0-----� ----- n � --------- ....-•-• City -------Ml-TN�C-6----------------------------------- Contractor's Name ------�O-W__/_1_tF—�---------------------------------------------------License # --------:-------------- Phone ---------------------- Installation will serve: Residencepartment House❑ Commercial❑Trailer Court ,❑ Motel ❑ Other -------- ---- - --------------- Number of living units:----I_____ Number of bedrooms arbage Grindery�S__ Lot Size --- ------- Water Supply: Public System and name ---------------------------------- :1 .-- _ eat_ . _5and Loam ----------- ---------Private— `: Character of soil to a depth of 3 feet-,, Sand ❑ Silt'. ].. r._C_a_yCJ,..,Pea. ❑�y_�� y Clay Loam:❑ Hardpan ❑ Adobe ❑ FilhMateria! /1d_ _;If yes,type ---------------------------- (Plot ----------------------- --(Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) t T. NEW INSTALLATION: (No septic tank or seep a pit permitted if public sewer is available within 200 feet,] �r PACKAGE TREATMENT [ ] SEPTIC TANK![I" f Size---K]Q---x_- ----------- Liquid Depth ----- -_---..____ Capacity Compartments --_��. ------ I'll — `t --F6uridation1V----- Pro Line � ante to neares#:4 Wel��- ___ ____________ -- - -- _ _ p. __-:- s LEACHIN .QNE [ No. of Lines i---- -------, Length of each line------- Q--77.------ Total L7 gth ----A6.©--_ --_ ---- � p : r' ----3--�� Founddtion •_ _� 'D' Box��Type I•'iiter_Materia G�_.Depth Filter Material I -�--Z Z...r___...... v� 1 `1 't f - f r "'t�� - Property Line �� Distance to nearest: Well ---------- ---- ��••-•-----=---- SEEPAGE PIT [ ] „; Depth --------- --------? DGameter -----=---------- Number ------------------------------ Rock Filled Yes [] No i❑ Water Table Depth 1' -:__ -__Rock Size " -- ------- --- -- \Distance to nearest:,Well----------------i------------------------Foundation __--_----_--_-_ ---- Prop. Line -_-__----_--_...__.— Date ------ ti. 3 REPAIR/ADDITION(Prev. Sanitation Permit# i-------:--------- - ';•-- 1 Septic Tank (Specify Requireme ts) { ` r s u ---------------------•--------------------------•- r,a t i F -------- "----,4------------- Disposal Field (Specify Re uirements) ______________-�---------.--------------------------------- �t'. -------------------------------------•- -------- --------- ----------------------------------- :- ---: - (Draw ekisting_and..requi,red addi#iron,.on-reverse side) I hereby certify that I have prepared this-dpplication 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 si ture certifies the following: "1 certify r in the pe ormanc of the work for which this permit is issued, I shall not employ any person in such manner as toe subject to rk ompensation laws of California." Sig Owner By ------------------------------------------------------------ --------------------- - -0- - Title ------------------------------------------------------------ (If ------------------------------- --------------------- - - (lf other than owner) FOR DEPARTMENT USE ONLY APPLICATION-ACCEPTED..-BY. . t T DATE --- -- / BUILDING _PERMIT.. ISSUED ----- = - --- - J y' ° - --------------------- -------------------- : .DATE ADDITIONAL COMMENTS __ ------------------------------ --------- -- ----- ----------- - - _ / - -F -- - - ----------------- ------------- -- ----------- ------------ ----.-.-------...�x.�....-------------- - - ------------------ ---------- - -------------- _ --- _ . ' FinalInsp ------ ---1----- - ----- ----- ------ ------------------------ a e ---------- SAN --------SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'6$ Rev. 5M