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FOR OFFICE USE: ( z,� e Le APPLICATION FOR SANITATION PERMIT 1 �6 -------------- -------------- _ }Complete in Triplicate) Permit No. This Permit Expires 1 Year From Date Issued Date Issued Applicofion is'hereby made to the`SanJoaquin'Local Health District for a permit to construct and install the work herein . described. This applicat'on is made in compliance with County Ordinance No. 549 and existing les and Regulations: N JOB ADDRESS/LOC ION .L_-__ -- '__ _______ __.�I1a- -,� E SUS TRACT --- -`S.___-__-- /' , Owner's Name .--- ��f��y-�--------- --1--------�-L_�y� -�-�-�-�- -�'-------------- ------ - - - -. ----- --- - -Phone��---------�- ----------- Address ------ T { f Com``"` `"- - City� ------------------------------------------ f�-- --- Contractor's Name ------ Installation ____ ------------------------------------------ ------- � __ __ _____ ___________ License #907/1/11111- Phone 4�-3.3-%4-0.77 Installation will serve: Residence XApartment House-[] Commercial :❑Frailer Court ',❑ Motel ❑Other ---------------------------------- --------- f Number of living units:_______ Number of be ooms _ __.__Garbage Grinder � --- Lot Size/ ._ °� '- 1 - -------------•--- Water Supply: Public System and name ------- _ _ A-_ ---.---fiv. --------•--------------------------------------------Private k`. Character of soil to a depth of 3 feet: Sand'❑ Silt 0 Clay ❑- Peat❑ Sandy LoamY_ Clay Loom..0 Hardpan ❑ Adobe '❑ Fill Material ___________ 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 pit permitted if public sewer is available within 200 feet,) �J PACKAGE TREATMENT { ] SEPTIC TANK[ ] a. ;. Size------------------------------------------------ Liquid Depth __________.__-.__---__. M. IF 01 Capacity ------------------- Type -------------------- Material---------------------- No. Compartments ------•---- ------ Distance to nearest: Well --------:-------- ------------------Foundation ---------------------- Prop. Line -----_---------------- LEACHING LINE No. of Lines --------/------------- Length of each line------- 10_k-------------- Total Length _______y6�-_________-__ 'D' Box .---/----- Type Filter Material T -------Depth Filter Material `r_____________________________ Distance to nearest: Well ____s��i----------- Foundation ___fib_`______________ Property Line __..-- `. _._.. SEEPAGE PIT Depth ___1A----------- Diameter -y_.2L_ _ Number ---------/-_______________ Rock Filled Yes No i❑ ,::7 Water Table Depth --------s --------------•---------•-------Rock Size --------�.X---•--•----- --- kwe, Distance to nearest: Well -------/46/--______.________---Foundation ----1ZI-------- Prop. Line ...3.f........... REPAIR/ADDITION(Prev. Sanitation Permit# ____________________________________________ Date __________________________________1 Septic Tank (Specify Requirements) ---------------- -------- --------------- . ----------- Disposal Field (Specify Requirements) --- __ l____ .t�&i____ 3P� � _ E7---------------------------------- --------------------------------------------------------------- ---- ------------- ---------------------------------------------- --------------------------------------------------------------------------------------------------- (Draw existing and required addition on reverse side) I hereby certify that 1 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- "[ 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 of California." Signed ______.._.__._- Owner - - ------------------------ By -_�t&__w�ner) ----------- -------------- Title -----�------- - ----------- ------------ --------(If other _ FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY �t .Q►--____________ ---------------------------------- DATE __, -1 -------------- -------------- -------------- BUILDINGPERMIT ISSUED --------------------- ------------ ------------------------------------------------------- ------------DATE ------------------------------------------- - ADDITIONAL COMMENTS _- --- --- - ------------------ ---- ------------------------------------ --------- ------------------------- --- ------------------------------------------------------------------------------- -------------- --- -------------- ----- --- ------ --- --------- -- ---- ------------------------------------------------------------ - - Final Inspectio Date �.----- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M