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FOR OFFICE USE: "`APPLIICATION FOR SANITATION PERMIT 1-1 Permit No: { JComplete in Triplicate) ' _t `" -0-, Date Issued This'Permit Expires 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 in compliance with County Ordinance No. 549 and exit gRules and Regulations: JOB ADDRESS/LOCATION .-- _ -- � - - �r_ -15/ lrn -- - -----------CENSUS TRACT/ ------------------------ 3r ----Phone �_Y1 Owner's Name __ -74 � - r -------------------------------- -------- Address ! r Y --------/ _vC�tY _ Contractor's Name -- -- -h -- -t--License # ------- -:-- __ Phone i. I Installation will serve: - Residence � partment House❑ Commercial❑Trailer Court Mote! ❑Other------------------------------------------ / Number of living units:___------ Number of bedrooms - ------Garbage Grinder __f- Lot Size --- ' a Private ❑ Water Supply: Public System and name ---------- Y-1---J- ""P------ — Character of soil to a depth of 3 feet: Sand 0 Silt C1Clay E] Peat E] Sandy Loam ❑ Clay Loam Hardpan ❑ AdobeX Fill Material ------------ If yes,type---------------------------- E (Pl'ot 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 sewer is available within 200 feet,] SEPTIC TANK Size_- ---- X5X --_ liquid Depth ---- PACKAGE TREATMENT { ] \ Capacity _j_�L¢Q------- Type Y Compartments .._.. = Distance to nearest: Well ___ __C) >/ 1 _ _-.Foundation _ _ __ Prop. Line __ r. Q___ Total Length il----- No. ' LEACHING LINE of Lines Length of each line -_-- e th Filter Material __--4-- - ------------------- 'D' Box __t -- Type Filter Material � `U- - P �~-- J _ .� O- j----- - Property Line. ___ - - Distance to nearest: Well _ __ -Q--- -- -= Foundation _- -_-__-- l SEEPAGE PIT � Depth ��----- Di meter};�-,3----- Number ---------- --- /-� hock Filled Yes Na (9) Water Table Depth ---- - -------------------------Rock Size -_-_ -- -- - --------- - -------------- - r -- ` Distance to nearest: Well -------[-31!IL1 Foundation �_ Prop. Line - --- ---=-----•- REPAIR/ADDITlON{Prev. Sanitation Permit# --------_----------------------------------- Date ----------------------------------] Septic Tank (Specify Requirements) ---- ----------------- -------------------------------------------------_---- # Disposal Field {Specify Requirements] __----- -- -------------------------------- -------------------------------------------- ------------------------------Y ---------------------------------------------------------- - 1 ---------- ------------------------------ -------- I __------ A. (Draw existing and required addition an revers side) I hereby certify that I have prepared this application and that the work will be done-in accordance with San Joaquin . s of the San Joaquin Local Health District. Home owner or licere- County Ordinances, State Laws, and Rules and Regulation sed agents signature certifies the following: person in such manner "I certify that in the performance of the work for which this permit is issued, ! Shall not employ any as to subject t Comp tion laws of California."' Signe --- ----------- --- ------ Owner - ---------- ------ !�- Title ------------ ------------------------------------------------- - a ---------- If other th owner FOR EPARTMENT USE NLY/ lp APPLICATION ACCEPTED BY_ -e--d----- -- --- _ DATE -- '�--- I -- ----------------- -------------------- --------- ---------- DATE ------------------------------------------- BUILDING PERMIT ISSUED -- ADDITIONAL COMMENTS��----��=__G'f - := - - - -------------------------------------------------------------------------- ----------------------------------- ------------------------ ---- --------- --- - ------- ----------------------------------------- - - -- -------=---- - --------- - - ------------- ----------- --- - --- - - Date �--- ------------------ Final Inspection b --- -- SAN J AQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M