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FOF OFFICE USE: APPLICATION FOR SANITATION P Permit �. mit No. - g =x. (Complete in Triplicate) Q ----------------- -r r" Date Issued Z7&____�-r _y f = This Permit Expires 1 Year From Date Issued l the work herein q' : with Count Application is hereby made to the San Joa um Local HealthDistrictCounty inance for a No. 549 and existing Rules ermit to construct and #and Regulations: I described. This application is made in compliance w Y 3 7zjo - --------------------CENSUS TRACT ------------------------ JOB ADDRESS/LOCATION ------ r��-��---- _�-/V-- __'�' p_` -- -- ----- - Owner's Name ROW &Od'- --- - --r--------------------------------------------- ------------- - ----- Phone �-DG%t! ------------------------------•----- I Address - 11 /* =/'1 -- City I Contractor's Name -.-�i��_S.-��rr�---��---�- �-.4------- -----� License # /-7719`3---- Phone 4 - 'Z 7 Installation will serve: Residence ®'Apartment House'r-1 Comm I rcial ❑Trailer Court 'E] Mote E] Other ------- ----- --------------------------- Lot Size Number of living units:--.. ._.--_- Num `bedrooms _a� -----Garbage Grinder - - -' Water Supply: Public System and name:___�------------------------------- ----- -- --�------------------------------------ ------------------- Private ;e ( Character of soil to a depth of 3 feet: Sand❑ Silt El Clay ❑ Peat❑ Sandy Loam E] Clay Loam [I f ----------- Hardpan ❑ Adobe ®' Fill Material ------___ -- If yes,#YPe r E [Plot plan, showing size of lot, location of system in rela#ion to wells, buildings, etc. must be placed on reverse side.] (� f NEW INSTALLATION., ,z(No septic tank or:seepage pit permitted if public sewer is available within 200 feet,) PACKAGE LTREATMENT. [,j "'SEPTIC i TANK'[ Size--------------------------------------- q p Xi CapacifiY ----------- Material-------------------- No. Com artments -- -------------- Yp - 1 Distance to nearest: Well ------------------------------------Foundation ------------------ Prop. Line ----------------• , LEACHING LINE [ j No. of Lines -------------- -- Length of each line-----_----.------- ------ Total Length ---_--•--- De th Filter Material --------------------------------------••---- Distance to nearest:Pe Filter Material p D' Box -- --------- T t: Well ---------------- --- -- Foundation ------- - Property Line ------------------------- -------------De th - Diameter ---------------- Number ---------------- ----------- Rock Filled Yes ❑ No ❑ ( Water Table Det - -----Rock Size -------------------------------- SEEPAGE PIT [ ] P - Distance to nearest: Well -------------------------------------- Foundation -------------------- Prop. Line ------------•-•------- r • - --- --- Date ----- ---------------------------- REPAIR/ADDITION(Prev. Sanitation Permits# _------- ,, j ' Septic Tank (Specify Requirements) ---11,0 Gh---�/_y '� � p ------ Disposal Field (Specify Requirements) ------ -- -- -- ----- -- ------- - ------------------------------------ - ---------- ii----- -- ---------------------------- -------------------- -- F ------ ------ ------- ------------------------ ----- -------- - - - Draw existing and required addition on reverse si e 1 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- red 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 as to become ct tq�W�Lk an's Compensation laws of California." - ----- ----------I --------------------------------- Owner Signed J_ �� ,?---- - } ._ ------------------ Title --- By (If other than owner] FOR DEPARTMENT USE ONLY - - - --- ------------- APPLICATION ACCEPTED BY - T f� 'y - DATE . -------------------------- ----------- B--U--IL--D--I-N---G-- PERMIT ISSUED - -------------- '----------------------------------------- ADDITIONAL COMMENTS ------------------ - *, ------------------------- ------------------------ -- --------------- ----- --- --------------------------- - - --- ------------------- Date .. ---------- -- - - Final Inspection b SAN JOAQUIN LOCAL HEALTH DISTRICT 3 �I E. H. 9 1-'68 Rev. 5M.