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FOR OFFICE USE: � APPi.1�AT'iON�FOR SANITATION PERMIT - r . . 4` ».....Permit No 1 q k 'T{Compfete in�npIicate] ---------- --- ` s Date Issued9-,7 This Permit Expires 1 Year From Date Issued --------------- Application is hereby made to the San Joaquin Local Health District for a-, permit to construct and install the work herein described. This applicationis made in compliance with County Ordinance No. 549 and existing Rules and Regulations: t [� AA f JOB ADDRESS/LOCATION ._-- i�------ _! t CENSUS TRACT __A<__--_------- ------ � � q --Phone---------------------------- ------- Owner's Name --,(.i✓ � J�ta = ----.;. City __ ��<-tom 1 '1 ?----------------------------- ------ Address f �� -- -� = ��' .. ens o 14 Contractor's Name � � ��2-/'"----- ------- --------Lic e #1 �'.Zg_2 Ph hone �j��-'��" - R . I x Installation will serve: Residence Apartment House EJCommercial nTrailer Court ',❑ i Motel ❑ Other ------------------ --------- --------------- ' Number of living units:--- ----- Number.of bedrooms -�-_---Garbage Grinder . Lot Size .__---_-__------------------------ ------- Water Supply: Public System and name _ -_ � ---------------------------------- - --------Private ❑ I Character of soil to a depth of 3 feet: Sand'o Silt❑ Clay "❑ Peat ❑ Sandy Loam ,❑ Clay Loam ❑ I Hard an Adobe Fill Mater ---------------------------- A - - p ❑ � Material � If yes,type ----------------- --- - pp [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 ta9k or seepage pit permitted if public sewer is available within 200 feet,) ' PACKAGE TREATMENT [ I SEPTIC WANK X Size_-- - r _ �--- ------ Liquid Depth ---------------- �1 s� Capacity _p -:-- Type ' aterial _ l7 ---- M No. Compartments _-_.'L.............. i Distance to nearest. Well ; ,^^--_-_--_-_-_-------Foundation -/Q----_.-----Prop. Line_-- LEACHING LINE No. of Lines ____. -------------- Length of each line-,__ . -------------- Total Length _l _ ____.•_.:=-- 'D' Box V.<!,)---_Type Filter Material,/j__I&,-'/Depth Filter Material __fer�.�----------- , -- - --•-- `- 1. i � i Distance to nearest: Well ___.__--------- Foundation -;. __ Property �-- � :, w.�. , „Pro e fine SEEPAGE PIT 4Q Depth _-- Diameter _-__ Number --- -------------------- Rock Filled t Yes X No �+ � sr ` Water Table Depth --- 1150- Rock Iize - ------- ----------------- -+�'-----------------_Found,ation --�f�---------- Prop. Line ---. _- ' - Distance to nearest: Well ------- --------••--•-' REPAIR/ADDITION(Prev. Sanitation Permit# ------------------------- ------------------ DateJ-------------------------------) Septic Tank (Specify Requirements) ---- -------------- '-------------------------------------------- ----------------------- - k y Dip[sposal Field Specifty Requirements).�----------=--------------------------------------- ------ --------------------------------------- --- ----------- --------------- ------------------------------------------ -------------- F -------------------------------------------------------------- --- --- --------------------------------------------- -------------------- --------- -- --------------"-___- -------------- ----------------------------' -------'--""""--'-"---'----"---""----------"-----'---------'_-_--- ---------------- -"---------_--------------•- (Draw existing and required addition on reverse side) ) I hereby certify t at 1.-have prepared this application and that the work will be done in accordance with 5t�r� Joaquin f Cou ty : rdinancs State L ws, and Rules and .Regulations of the San Joaquin Local Health District. No a owner or licen- s . sed agents signature erti�iel the following: r "I certify that in the performance of the work for which this permit is issued, I shall not employ any person. in suchmanner � as to become subject to Wo�krtarril Com.pensctioln'luws:of Cnliforni6: ' Signed --------------- --- ---------------------------------- !------------- Owne)mI04 Ir/ ----------- Title -- - ------------------------ t [If other than dwner)� t OR"DEPAIRTMENT�"t10E ' APP ICATION ACCEPTED BY .____ ___ �� ,c. TE _1-4 ------------------ tDINGPERMIT ISSUED -------------------------------------------• - ---------------------------'--------DTE - )-1--------------------------------- AD61TIONAL COMMENTS ------- --------------------------------------------------------- ------------------ � � �;r = --------------------------------------------- ----- t-----------------------------"�-------- I -------�'.�----------------------- --------- R -------------- --- -- ----------------------------- ..- -' 1 E »� ----- -.Date 4 ---- � ---�----- Final Inspection by- ---- _. L �.e ry -»--- - y--- - -SAN',JOAQUIN -LOCAL.,HEALTH DISTRICT- E. H. 9 1-'68 Rev. 5M