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OR OFFICE USE: APPLICATION FOR SANITATION PERMIT ---- --------- ----------------- ------ (Complete in Triplicate) Permit No. ---------=---------------------------------------------- • Date Issued ----------------- ------,------------------------ This Permit Expires 1 Year from Date Issued Application is hereby made to the Sapla n Jo- cal Health District for a permit to construct and install the work herein described. This application is made i com ce- ith County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION .� ,_- -t_ -- -_- � --l�r�'��-� _6EI SIDS TRACT --------------•.---------- Owner's Name -----l� �1� Q --------------------------------------------------------Phone ------------------------------------ Address a city -----x(} 71 ----------------------•- ------------------ Contractor's Name �. f1- ---------------- -=--------License # Q-7 7-3 J---- Phone Installation will serve: Residence . partment House[] Commercial ❑Trailer Court Motel ❑ Other --`----------------------------------------- i Number of living units;--------1-•,Number of drooms - - _-- Garbage Grinder y:a----- Lot Size _--- -3_-k�l '------------------- Private 4 Water Supply: Public System and name ` t t =- ❑ Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ ,Clay-Loam ❑ 5 Hardpan ❑ Adobe ,!I Material✓t-�4) If yes,type ---__---------------------- i y (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') ' ------ � __.--1-1- -------_ Liquid Depth _--- � ---------- Capacity -�_2-Q-0- ----- Type&X/m.terial !0-*� No. Compartments ---------- .- 1 Distance to, nearest: Well, ------------- ----------------------Foundation --------- Prop. Line __ __:----------._._ � LEACHING LINE [�' No. of Lines __- -------------- Length of each line..-_ f__ r__- Total Length � .�_.__________.. le D' Box -�S Type Filter_Material --------------------Depth Filter Material '------_-__--_________ _______.------------ �- Foundation --J________-- Pro er Line __ v--—- Distance to nearest: Well ----------------------- p ty SEEPAGE PIT Depth __ S_. ------ Diameter _33 -_-- Number .__--.- ----------- Rock Filled Yes @moo ;i❑ Water Table Depth - -------_ '- _ yl --------------------- Rock Size -1� .X Distance to nearest: Well --------------------- --------------Foundation .__-- p--_..... Prop. Line ...54 REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date --=_-------- --•--• =�''_-) Septic Tank (Specify Requirements) --- -1 ' '� ---------'----------------'--`--------------------------------------------------- -:-'E------'-- --------------- ------------- y . Disposal Field (Specify Requirements) '----------------4- _ _ •- � S-• r rE t ---- `^ -------_.----_--- -----_' -___"-__-_-_--------_--_---_---_----- ---------------------- ----------------------------------------------------- - ----`-----------* ---:---'---------. ---------------- -- -- -------- -- --------------- ------------------------------------ ----------------- --------------------- (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 tlie_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 as to become subject to Workman's Compensation laws of California." Signed - -- ---------- - I rn ---------------------- ---- ----:( Title (��` " `� rQ (If other than o r FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY --f-- ---------- -'� -------------------------------------- DATE ---- �f-- - BUILDING PERMIT ISSUED ` DATE ADDITIONAL COMMENTS ------------------:------__ -------------------------------------------- --------------- ---------------------------------------------------- ------- -- --- -_ --------------------------------------- ----------- --- � , ----------------------------- -- ----- _ ---------- ------- ---------------- ------------ �------ Final Inspection bY• � ---------------------------------------`------`= rt---------------------- Date a� SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M C, Y .r-