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FOR OFFICE USE: "` l APPLICATION FOR SANITATION PERMIT ----------------------- "--------:---------._ Permit No. ----(/ 5-5 a: (Complete in Triplicate) - Date Issued .1 z_=_� -71 ---------------------------------------------------------- -_----------_---_-----------------------_-----------_- This Permit Expires ires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Health District for a per to construct and install the work herein described. This application is made incompliance with County Ordinance No. 549 and existing Rules and Regulations: © JOB ADDRESS/LOCATION ---3d --!_57-----�-------- ---------- -'-----CENSUS TRACT ----- _`_��.-- r Owner's Name ---------,D_t9MA_D---------LrnR------------------------.--------------------------------------Phone ------------------------------------- Address ----- •-------Address 30b,9-J---.______- --- -iE------C.E?_-m-a----- --------•--- City --- sc_ Lo ------------------------------------------ E Contractor's Name 1 - ----------------------------------------License # ------------------------ Phone ------------------------...- Installation will serve: Residence �rtment House'❑ Commercial:❑Trailer Court !❑ Motel ❑ Other -- --------------------------- " 'F Number of living units:-----/____ Number of bedrooms 3------Garbage Grincle Lot Size _A_ -1 1� - .--'---�--- Water,Supply_Public System_and name -�--------- -------------=-- ---,-- --------,,, L -----------•----•----•- Private Character of soil to a depth of 3 feet: Sand❑j;"'Silt El Clay ❑ Peat Sandy Loom -[I Clay Loam Hardpan Adobe'❑ Fill Materia—I /41--I-IA If yes,type ____________________________ (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) 51 NEW INSTALLATION: (No septic tank or seep" pit permitted if public sewer is available within 200 feet,) /,f PACKAGE TREATMENT [ I SEPTIC TANK ( Size--_ )(119-X_$ -Liquid Depth __Ao-._______._.-__ '9 Capacity .1,50 ----Type PHECASI_Material_6OMCRT No. Compartments ---:7?7=— ---• { r r � V'I istance to nearest: Well __, ___ _____________Foundation _1�---"F------ Prop. Line ____---:5`___ r Total ten LEACHING LINE [ No, of Lines ----- ---------- Length of each line ------ gth ____� _____._._. fb ,Q) cn 'D' Box E-S-•- Type Filter Material RQGK----Depth Filter Material ----/___qq__ "Ditance to nearest: Well __J�✓-- --- Foundation _!_ _' ------ Property Line --�----�...... SEEPAGE PIT [ Depth _ -- ------- Diam�(er f�-__ Number -----_��__--------- Rock Filled,I Yes No C] j Water Table Depth---� l--------------------------- --------Rock Size a I f Vit\4 Z�t(I :N < < Distance to nearest: Well _-_ W---------------- '^«�i ndl n �----'- --- Prop. line ------ ........... (Prev. Sanitation Permit# ______-----_- �� ------------------------ Date ----------------•-•-------------•--)c Sept is Tank (Specify Requirements) - _ ----- - -.._________ E_____________________________..-----.________-___________.__�_ .____ Disposal Field (!!Spec fy Requ reiments)_--W-------I----------------------------------------- ---------------------------------100------------------------------------- 1 ----------------------------- -L _ -f-------------------- - :' .__ - - - '= _ .. �If ' -------------------------------- - - (Draw existing and required addition on reverse side) ' I hereby certify t at I have prepared this application and that the work will be done in accordance with San Joaquin Regulations of the. San Joaquin Local Health District. Home owner or licen- sed agents signot6re certifies the following: "I certify a n the performance of the wor for which this permit is issued, I shall not employ pny'person in such manner as to.4� )subject orkman'�Oa aws of California." 'x I Signe , _ OwnerB ) ) Q tle -- -- ------------ - -------- ---------t - - - _ Y ------ i ------------•- --- ---------- T' fi r ! Of other than owner) �- t FOR DEPARTMitJT,'bff ONLY r -�-----` --------------------------------------- _ _ DATE -..�r�� '- ------- APPLICATION ACCEPTED BY - ----------- --------------------=------- - ----------- �� ---- •- i .BUILDING PERMIT ISSUED -------------------------------------------------------- -------- -----------=--------------DATE ------- -----•---------------------•---•-- ADDIIONAL'CON4MENTST_ ---- --T--- - -- ---••------ ------------------------ --= -------------------------------------- r r '� - = -- ----- --------- ---- ----- -- -- ---. -w. _.- .�:.- ------- - -- - -- - - ----- ----Q____ ------ --------- -------- ----------- --- - ----- ---- - Final Inst '��- .-- ----- -- ---- - - - -------- --------------------------- Date -- _T % ----- . # ` SAN JOAQUIN LOCAL HEALTH DISTRICT i• E. H. 9 1-'68 Rev. 5M .�_..-..