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FOR OFFICE USE: -- APPLICATION -9OR"'fANITATION PERMIT -- --- --- ---- ----- --------------- (Complete in Triplicate) Permit No. ' ------- --------------------------------------------------------- - This Permit Expires 1 Year From Date Issued Date Issued __ y_~ , Application is hereby made to the San Joaquin Local Health District for a permit to construct.6nd-(n'stall the work herein described. This application is made in compliance with County Ordinance No. 549 and existing-Rul'es and,,.Regulations: JOB ADDRESS/LOCA ,ION C�`S- L- _l 1. `1 � �C e 9 -f-_ ^�7 ENSUS TRACT :- V" .___. Owner's Name _..__ . ---- {J_T ------------------------------ -- :'_--------- �----Phone -----------------------------....... Address .....< -----------. City ------ --r-�� --- Contractor's Name -Ih�l ---' _------~ ------- =v "= Lis e # Phone Installation will serve: Residence Apartment House❑ Commercial :❑Trailer wt t.t Motel Other -------------------------------------------- F eA i �., I Number of living units:_:---/_._ Number of beedrooms _____Garbage Grinder____, Lot Slze�.!__�"� Water Supply: Public System and name ----------- - ------- --------------------------------------------------=------------ '-t Private Character of soil to a,depth bf`3 feet: Sand'❑ I Silt❑ Clay ❑ Peat❑ Sandy Loam Clay Loom .E] Hardpan E] �Adobe ❑ Fill Material if yes, type_ _---------------------- (Plot _____ _____________(Plot plan, showing size of lot, location of system in elation to wells, buildings, .etc. must be placed on reverse side.) seep ` olpermitted i public sewer is avail-able aabl within 200 feet,) rr NEW INSTALLATION: (No septic tank or PACKAGE TREATMENT I ] SEPTIC TANK'[ �"�E Size___ ______ _�Q___._ __. ._.__ Liquid Depth ------ r-....,__.-- Vl . Capacity--- - -- �'Typ�e eo-AMaterial__ oAkk.r Compartments ---------- -- r istance-tomnearest: Well ----- �----------- --- Found tion _Ae_fi`--- Prop. Line ---- LEACHING --LEACHING LINE No. of lines __ _-_ ___._______ Length of each line------ Total Len th _.__f .��........ ..__ D' Box 1�I a Type Filter Material J'KJ` _l_ Dept Filte� Material .____ .________________'____________-._ r Distance to nearest: Well _ - Foun&fi'on -.�[/ - Property Line ------- --- -� SEEPAGE PIT Depth -------- Di eter<v_X>�Z._ Number __________ ___ __f ------ ,,Rock Fill d Yes � Water Table 5,pepth --,� '- -_-- Rock Size, (_ _T1i r i Distance to nearest..>,Well ------ -� ______________________Foundati n _��_____ _.___ Prop. Line �7.. i REPAIR/ADDITION T rev. Sanitation Permif# _________________________ __ ------- Date ---------------------------------- Septic Tank (Specify Requirenients) --------------------------------------=; Disposal Field (Spec-ify Requi/ements) ------------------------------------------ ------------------------------------------------- ----I------------------------------------------------------------------ -------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------ :--------- (Draw existing and required addition on reverse side) I hereby certify that I have prepared this application add-that the ,WCr Will -he-done-in-accordance with San Joa§pin ceq County Ordinances, State laws, and Rules and Regulations of the.&xWJo 'uin;Local Health,District. Home owner or'Iicen- sed agents s' tura certifies the following: --, ,4 a ( I "I certify t the perf rmonce of the wor for.w ich this permit is issued, I shall not employ any person in such manner as to beta subject t kman's p i.o# aws of California." i ; Signed _-- -- Oyvner_ ------- ------'----------------------- . y - ` . it --- --- (If other than owner) t FOR DEPARTMENT USE ONLY r APPLICATION ACCEPTED BY ---------�R-0-----I-----------------� - -----------------------------------------•------ DATE ---- 4.:V_i ---�_ BUILDING-RERMI-T_ISSUED---�---- ----_ ----_... -----------• -----._....__.w._r:.--:..:.-� _-__�:____._-_:DATE -:----------- ---------------------)------- ADDITIONALCOMMENTS ------------ - ------------------------ -------------------------------------------------------------------------------------------------•-------- ------- I i !"t>, " ___________________________ ______ __ _____--__-____k _ _r _____ __ _ _v_-_=__y'__7. ____-__.__________..__-__.-___-.____----------------------------------------- ------- -------__---------------- ________ _ __________________ _____ ___ _ ___________________________________________________________________________ _ __ __ - ______________ -- --_ _ _ ___ ___ _ ____---------.-----------------------------------}JF_ ______ _ Final Inspe -------.Date --/ ( L/ SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M