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FOR -OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No: ______ (Complete in Triplicate) 7 3 ---------------------- -=----------------- -------------- __:3_-/3 � ~ . ---------------------------------------------------------- This Permit Expires 1 Year From Date Issued Date Issued Application is hereby made tc 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 existing Rules and Regulations: JOB ADDRESS/LOCATION -- 3�- ----- ---____-- _ , ---------------------CENSUS TRACT - -�" ____-- Owner's Name ---/---- ��-Q------- --- �, �� '--------- -------------------Phone .Address ------------L_,/-F ---------S------- -------- } ------ City C _ ------------------------- Contracto"r's Name _f VJ;77R..------------ ----------.___a_.License # Phone .-----------==-------- Installation will serve: Residence ❑Apartment House,❑ Commercial ❑Trailer Court i❑ Motel ❑Other ----------------- -------------------------- EAX Number of living units:__--_l_____ Number of bedrooms -- -_____Garbage Grinders__ Lot Size _.11 -_____________ Water Supply: Public System and,name ---------------------------•----------------------------------------------------------------------------------Private Q_� """ Sand Loam Cla Loam Chiaracterof-soil�to-a-d�epthof�3feet: �-Sand'❑-4 Silt.❑- ,:Clay,..❑ ;Peat-❑� y__�,•;❑� y �� . . . Hardpan [< Adobe ❑ Fill Material ------- .... if yes, type ---------------------------- (Pl'ot plan, showing size of lot, location of system in relation Ito wells, buildings, etc. must be placed on reverse side.) NEW INSTALLATION:(No-(No —or_seepage-or -seepagesewer is available within 200 feet,) .._- 4 _ PACKAGE TREATMkENT [ SEPTIC TANK'[ �x Si e_-._�7�___X_11 o_X___-______- _____ Liquid Depth ---- D N Capacity ��e�____ Type/_/Q _ Material__ /CR No. Compartments - �- Distance to nearest: WeIIL :_______r-.�__ _ Foundation fU__ - Prop. Line .___�_ _ LEACHING LINE [orle No. of Lines _ -------- r L•eglth ofTre_alh like---/—_____________ Tottl .Length ____ ..... - ---- - --- ----------- ( !� D' Box _ s Type Filter Material __�_�_�KDepth Filer Materia'I ____-_1 --------._4__x_7._.______._ Distance to nearest. Well ::s_ ___ Founda - - tion ________________________ 1 �oo entyiLinO _ SEEPAGE PIT Depth 1YDiameter T :_ Nurf r _____i__ _—_____,__ ___ iRock Fille Yes ®—No .0 ----�'� -____- a s r fir Water Table Depth _____ ---------------�_-..._-- Rock Size _ _ _L______r �__2 . ' Distance to nearest: Well .� _-- ---------!__...Foundation ____�G<-_:____ Prop. Line ......-�. ------ REPAIR/ADDITION L_ :i REPAIR/ADDITION-(Prev. Sanitation Permit# --------_--------_____________�------------Date---------_----------- ,_____ ___) Septic Tank (Specify Requirements) -------------------- M� ----------------------=-•--------------- ------------------- --------- 11 1 Disposal Field 1(Specify Requirements) -------- ! �` i+ I' ---{------ - --- ------------------- ---------- -------------- ----------- - - tT (Draw existing and required addition on reverse side) I herein certi . th t I have prepared this a lication and that the work will 6e done in accordance witFr San Joaquin Y p p pp q County Ordin�nees,]State Laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner or licen- sed agents si nature certifies the following: "I certify t t in the rformante of*e work for which this permit is issued, I shall not employ any person in such manner as to g e e subject or m��;� -romp nsation`haws of California." Si n Owner BY ------------ ---------- -------- ----------------------------------------------TA-C ------ Title --- ------ ---- (If other than owner) 75__R__%-_0_,FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ----- ---------------------------------------------------------------------. DATE ------- BUILD.ING_P.ERMIT ISSUED_---------__ __ --DATE��y__------------------------------- ADDITIONAL COMMENTS ------------ --------------------------------------- ------------ '-Um �--;--. t = -} - '"� '- ?t�-i----------�------'k------ -� -------- -------------------------------------- - Final Inspection by, l Date SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M