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FOR OFFICE USE: D ,}V APPLICATION FOR SANITATION PERMIT I' --------------- dam ---- •� (Complete in Triplicate) Permit No. _�__a_�______... ... ---------------------------------------------- ----------------------------------.�----------------------- This Permit Expires 1 Year From Date Issued Date Issued -b_�7�70 Application is hereby made to the San Joaquin 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 _ 7-------- , /4'-------/rC' --------------CENSUS TRACT -------------- ------ Owner's , Name -��------ ,Q. ------tzr------------------------------�:---------- - --- Address --------- R------------------------------------------------------------------- City ------------------------- -- - --------------------------- Contractor4 Name __-_L/ 5..__� l�Z ____ �t --------- --------License # � �_ Phone _ ._ Installation will serve: Residence E`Apartment House-E] Commer6al ❑Trailer Court ',❑ Motel ❑Other -- --------- --------------------- ----- i .. • Number of living units:--- -------- Number of bedrooms __._._Garbage Grinder _ 6 Lot Size .�_._Z;�� --------------- Water Supply: Public System and name ---------------------- --------•-•------------------------------- ---------------------------------------------Private4N, 4 Character of soil to a depth of 3 feet: Sand❑ Silt❑ Gay ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ ( Hardpan ❑ Adobedy 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,) PACKAGE TREATMENT SEPTIC TANK' Size--_ ___�_- f� � � ,�. �:�_S-_-��_�------------- Liquid Depth --101----------'----�-•-• rA Capacitylv7045 Type�,eP_� >`Material4101VZ-72No. Compartments Distance to nearest: Well �________________________ _Foundation ------------ Prop. Line -�----------------- LEACH / � ---------------- LEACHING LINE [ No. of Lines _-_____r______________ Length of each line-_ -,40.----_-.------ Total Length:___/O_.f_�.._.____._.__ D' Bo0, ' ___ Type Filter Material / DGIe___De Depth Filter Material _- �r Yp p ` -------. 0 Distance to nearest: Well --------- Foundation ----/_fir--------- Property Line ______--._. SEEPAGE PIT Depth ------ Diameter ----- Number ------------1-------------- Rock Filled Yes fil No :o Water. Table Depth -_`_-7e4P-r--------------- -------------Rock Size __-t�_��_________-- Distance to nearest: Well ----/00------------------------Foundation _la----- Prop. Line _---------_-- REPAIR/ADDITION ..:5--_.._-.._.REPAIR/ADDITION(Prev. Sanitation Permit# -------- ----------------------------------- Date ---------------------------------- Septic -------------- .-----__-----Septic Tank (Specify Requirements) ----------------------------- ----------------------------------------------------•---------------------------•------------ Disposal Field {Specify Requirements) ----------- --------------- -------'------------------------------------------------------------- i. ° --------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------ ------------------------ --------=------------ -------------------.------------------------- ------------------------------------- ------------- (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 certify that in the performance of the work for which this permit is issued, I shall not employ any person in such manner G as to r becombjecAtrkZ's Compensaton laws of California." Signed Ow ner-------------------------------------------•-- By ---------------•--- -------------------------------------------------- ------- ------ -Title ---- -------------------- - (If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY 5 _Xyl------- ----------------------------------------------------------- DATE ------------------- BUILDING PERMIT ISSUED ------------------------------------'-------------- - -----DATE ------------------------ ADDITIONALCOMMENTS --------- ] J�t 1�----------------------------------------------------------------------------------- ------- ---------- _________________________________________________________________________________-_--_____-____-__ � T-) gip•- ---- -- --- --------------------------------- ----- - --•----------- -------------------------------------------------------------------------------------------(�; P FinalInspection by: ----- ------ - ------ ------- ----- ----- ---------- •---------------------------------------Date ---- ---- -��-------------- • SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M.