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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No. --- -�_�� --------------------------------------------- ---------------------' ---------------- - (Complete in Triplicate) --------------------------------------------- p l� 3 . Date Issued ----._�-----�. .� ' --- ---------------------------- ------ This Permit Expires t Year From,bate 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 in compliance with County Ordinance No:P549 and existing Rules and Regulations: , JOB ADDRESS/LOCATION .L_ __�_5 .--...... Utz-`'"'�i.r ��.J--��C :- CENSUS 7RAC�'S� Owner's Name --- .. )----- #----Phone ----------------- --------- ---•---- ` 3 city --- --------------------------- f Address --------)---------- " p rr ; Contractor's Name -.____-- . -cd -- --- - - License # /d 1t`- done ----------------------------- IF Installation will serve: Residence E] Apartment House-[_ Commercial:❑Trailer Court t >0S Motel F1 Other -- s��---- - Number of living units:------ Number of bedrooms -_'7'__--Garbage Grin der___---- Lot Size ------------------------- Water Supply:IPublic System and name -------------- ---------------- Private ------------ t t ,... Character of soil to a depth of 3 feet. Sand❑ Silt❑ Clay, ❑ Peat❑ Sandy Loam Clay Loam Hardpan E] Adobe'❑ Fill Material �`Z`v- If yes, type ---------------------------- (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 seep a-pit permitted if ublic sewer is available within 200 feet,) ! __:_ PACKAGE TREATMENT ( ] SEPTIC TANK'[ Siz - Zf Capacity Liquid Depth ---------------------.----- Capacity -� .6 -2t.: -- Type ---- ---- - f Materi ; "s- No. Compartments `-----:...- istance to Weare Well _ -- ----------Foundation ---/ �-_-------- Prop. Line --115;---------------- LEACHING LINE No. of Lines ----- --____ -_ Lertgth.'of_each line--- - Total Length _______________ 'D' Box ---1 ------- Type Filter Material t r-;--Depth Filter Material --- ------------------`------------- R Distance o nearest�Vel.l -`-.w 'Foundation --------/,0 Property Line _--_--:-.._-__-..._---- u i�. SEEPAGE PIT [ ] Depth ------------------ - Diameter -----------------t'Number -------------- ------ Rock Filled Yes ❑ No .0 ' Water Table Depth -- --- --I----- I ------------Rock Size -------------------------------- V ?: Distance to nearest: Well ------- -------Foundation -------------- ---- Prop. Line ----.---..-.-.-.------ } REPAIR/ADDITION(Prev. Sanitation Permit# ----------------------------------------f---- Date ---------------------------------=1 J -- � Septic Tank'(Specify Requirements) -------------------------------------------- _ ---------- - - ------------------------------- -_,..------------------ -------- ` Disposal'Fie_ld (Specify Requirements) ----------- i" ---------------------------------------------------------•----------- T1 ---------- I uI ------1-�--------------------------------------------------------------------------------------------- ------- -------- ----- --- (Draw existing and required addition on reverse side) I hereby certify that 1 have prepared this application and that the work will be done in accordance with San Joaquin County2 rdinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner or licen- sed agents signature certifies the following: "I 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 Work o ensatio s of California." Signed --------- ---------------------- - --- --- -- -- ----------- Owner r� +.�LC ;Title ---- -- 1151141 -- ---------------- � {1f other than owner] FOR DEPARTMENT USE,.ONLY APPLICATIONtACCEPTED BY ----- ------ -- ---- - --- ------------------ --------- ----------------------------------• DATE ®------------------.---------------- IE BUILDING PERMIT ISSUED --------------- -----------------------------------------------O ---------------------- ---------------------------------------DATE AQDlTIONAL COMMENTS ------- ------ - ------ ------------------- ' -------- -------- -.------------- - -------------------------------- j I ---- ---- -------------------------------- ---- ---- --------------- ------- ------------------------ r ---- -- '`� - + Final Inspection by: - --- F ----- ------------------------------Date 7. Final ------------- -------- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M,