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_—_ ._ sh FOR OFFICE USE: P �y�,,�� APPLICATION FOR SANITATION PERMIT (Complete in Triplicate) Permit No. ................................................... � This Permit Expires 1 Year From Date Issued Date Issued .5. F-V Application is hereby !� � I .'� ' pp y 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,Ordinonce No. 5.499 ond,existing Rules and'Regulations: 1 �4h �':�� r.il.x J `L�./ ♦ .moi 1'CENSUS JOB ADDRESS/LOCATIQN ,._.:. _ _l�'l-...._.` :_,.... ............................ TRACT Owner's Name r �.�:�• _ I.A.Q P p _ . . .. ,_........... -...........Phone ---•-. .... Address ...•••• City _.. ._ -------. .. ............................ Contractor's Narttie':::.. 7p ',...... - • - .. 4License # :�bf'9 �• Phone .�.��.�.:.......'��.. Installation will serve: Residence 0 Apartment House0 Commercial (railer Court 0 b - t ; '4 Motel ❑Other ............................... u , . Number of living units:......... Number of bedrooms ............Garbage„Grinder ------ Lot Size ....mi�., .............. Water Supply: Public System dnd name pP Y --------=----- -----=---..__.... ....... -----•--•-----••-•. .........Private Character of soil to a depth of.3 feet. Sand 0 Silt❑ Clay 07-Peat❑ Sandy Loam 0 Clay Loam n I Hardpan ❑ Adobe V1 Fill Ma'tbrial ------------ If yes,type ----------- ........... I IE v (Plot plan, showing size..of•I ot,-location of. system in relation to wells, buildings, e'tc-, must be placed .on reverse side.} ! NEW INSTALLATION: {No septic tank or seepage pit permitted if,public sewer is available within 200 #eet,) PACKAGE TREATMENTSEPTIC TANK• Size...--=r ... { �`� -----•--- .-----•---•----- -------- Liquid Depth .......... --•- Capacity ` Type Material-_--------------- No. Compartments . . . Distance to nearest: Well _.•.................................Foundation _.._..---------_-.... Prop. Line ...................... LEACHING LINE No. of Lines g -_- — l -- `� .111 Length olieach!#ine.. -- LID-"----- Total Length ....hlCs.. ' D' Box • ' r i .... -.----- Type Filter Material .#....r_......._depth Filter Material ___._...1-..1..:..........•__•_......... ; r- Distance to nearest: Well _..... ..... Foundation, 3 0.::....... Property Line rQ............ i SEEPAGE" PIT Depth '------- Diameter Number ------- .. ............... Rock Filled Yes a": No ❑ ' Water. Table Depth .......... & ✓r -. --•..................Rock Size ... /p J* Distance to nearest. Well .... c ...,!!d_: Foundation ........ Prop. Line ___ .......... REPAIR/ADDITION(Prev. Sanitation Permit'# ....... I iDate 1` Septic Tank (Specify Re uireinients} .......................l = ............... ------- ► .y Disposal Field (Specify Requirements) ............... .__...-----•................................. • f I .................................................. ...................... .......................................................................................-__..................................... I (Draw existing and required addition on reverse side) I hereby certify that I have prepared this application and that the work will Eire done in accordance with San -Joaquin County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner"er licow sed agents signature certifies this following: "I certify that in the performagce of the worn for which this -permit is Issued, I'shall not employ any person in such manner as to become subject to Work4an's Compensation lawi--California." Signed ...... - F .-_-... Owner µ �' BY ---••-�-- - ..----...._ - -•. ._-_•-•_.. .:'..........:........... title _ (If other than owner) ' :~ PARTMENT USE ONLY i «E ' APPLICATION ACCEPTED 8Y ."r Z. •---.•...--••__�...•.......... ................ . . :. - ..... DATE ....�„1�1�7:.�---------------• BUILDING PERMIT ISSUED .._. ..... ..... ---- .. ' _ ..... =... ...........................:..............DATE _.................._..... ................. ADDITIONAL COMMENTS . - ••... . __ ..................... --------------- ...... ..: ......_.. Final Inspection by: } `` "•..t.. .------.Date . � ............... .... . .............:. D .....................1. .. SAN JOAQUIN LOCAL HEAI~tH DISTRICT4.1 y i E. H. 1�'b8-Rev:SM ! 7/72!3 M