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FOR OFFICE USE: = r } APPLIC�AVON FOR,SANITATION PERMIT . s" I - Permit No: (Complete in Triplicate) ---------=--------- ---------------------- ---- Date Issued This Permit Expires 1 Year From Date Issued }}` Application is hereby made to the San Joaquin Local Health District for a per mit 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 tr - ,r' `Fie------..e6el?--------- --------- Phone TR/ACCT ox-VA Owner's Name - ----------------- ---------- ---- . Phone 4-A--- - -------- Address ------------------o --- ------ -- --- -- -�1 City + z� I Contractor's Name _._________ --.License # c9ZC-7/_ -'-�- Phone /�//��Q� 1_______________ r- ;____... Installation will serve: Residence )(Apartment House-E] Commercial ❑Trailer Court ',❑ Motel ❑Other ---- -- ------------------------------------- Number ----------------------------- ----Number of living units:... Number of be rooms _______Garbage Grinder --- Lot Size --.X-, ' f---..----- Water Supply: Public System and name --- mow.r� G �'`�G`` ---------------------------------------------•--••-------Private ❑ Character of soil to a depth of 3 feet: Sand'❑ Silt❑�. Clay ❑ Peat❑� Sandy Loam ❑ Clay Loom Hardpan ❑ Adobe Fill Mciter'ial ------------ If yes,type ___________________________ p (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 seweris available within 200 feet,) (,v PACKAGE TREATMENT [.1. SEPTICTANK [ Size---- r-- -- Liquid Depth -__ _�- } 6` Capacit)/a," _�_ Type � t Material--L' r__ No. Compartments ___-Z_-______-P:.... Distance to nearest: Well ------APL. [_--______Foundation -_ 0 ---_-_---Prop. Line ___.S______________ LEACHING LINT: No. of Lines ------------- Length of each dline---- 5- --------- Total Length ---,1-�7 4�----------- 'D' Box __ 'D' Type Filter Material _/- -__=_ .De- ----'--.Depth Filter Material ------X 117 --------------- Distance to nearest: Well ______A '�Foundationt___Z4_r_-^ Property,Line-`°--�-__-_-.:.___ SEEPAGE PIT. k.Depth, Z_.:T— _:_____ -Di6meter�`_"?f Number ---------- Rock Filled Yes No i❑ Water Table Depth ------------�Q-1------------------------ 1--- ---y�--------- Rock Size r Distance to nearest: Well ----- 10-- ______________Foundation ___/__Q_ _____ Prop. Line ....�_____�....._ 9 ler .e.. REPAIR./ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date ------------------.:------------------) SepticTank (Specify Requirements) --------------------------------------------------------------------------------------------------------------- •--------------------------- Disposal Field (Specify Requirements) --------------------------••-- ----------------------------------------------------------------------------------------------------- --------------------- ---------------------------------------------------------------------------------------------------------------- - ----------------------------------------------------------------- -------------- ------------------- --------------- - -- -------------------- -------- - ------------------------------- ------------------------------------------------------------- (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: "1 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." t Signed ---- """_.. - - -- - -------------------------------------- - --------- -- Owner - -- -: Aw BY -------------- ------- Title ---------- (If other than owner) , FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED -'"----------- ----- -----------. DATE -------7--` /:7/ �------------- BUILDING PERMIT ISSUED ------ ------------------------- -------------------------------------------- ------------DATE ------------------------------------------- ADDITIONALCOMMENTS ------- Q -------Z2 ------------------------------------- -------------------------------------------- --------------------------- q _____________________________________________ _ ______ ___ _ _ _ ___---_____----______-_____ ____-----___-------____._________.-.-__------.____---_---________.__.________-______.____---_-. ___ - Final Inspection by. Date _ - SA JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M