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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT = Permit No774 __/10--- - -------------- E. (Complete In-Tripiicate) �-- ---------- - I ----------------------- ---------------- . I Date issued --------------- j 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 application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: i ,JOB ADDRESS/LOCATION -- --I lL ----- �� Qf WA-Ir-le _CENSUS TRACT ------------------------- Owner's ------------- --------Owner's Name ---- Q / Cl .� - = Phone =---------------- - r�1c ------ i9 'L- / -------. �� r------------------ city lr'�?sr� 7` 1 - ----------------------------------- Address __ Contractor�Name I/ _Z: 1 '--. r/t _______________________License # 7- `��-- Phone Installation will serve: ResidencesApartment House❑ Commercial ❑Trailer Court 'El Motel ❑ Other ------------------------------ --------- Number of living units:---- ------ Number of bedrooms _______Garbage Grinder Z3.- Lot Size -- �_/_f CR ------------ Water Supply: Public System and name ----------------------•--------•-•- --------------------------------------------------------------------------Private P Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ Hardpan ❑ Adobe'❑ Fill Material____------------- 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 seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT { ] SEPTIC TANK Size_____ __ -t�--- -- ��-------------- Liquid Depth _46------------- Capacityl�Q__Q4V Type ?!_ _ rMaterial�4.1�'No. Compartments -A______________ Distance to nearest: Well _: -_------------------- - --- P- _ Foundation-_-l_______________ Pro Line - -----------•--_-_-- �+ , LEACHING LINE No. of Lines ____ _ ________ Length of each line _00_ +;'=�' Ti�sal Length __ '�_q0............. Com_ Len 9 If 'D' Box : J� Type Filter Material jeoc ---.Depth Filter,Mdterlal -- -— -------------------•-------.:.- Distance to nearest: Well _- 0 Foundation ...... _ Property Line _-37�-r............. IF SEEPAGE PIT [ ` Depth --�-�- ----- Diameter /_ --- -- Numb 11 _.__ ----------------'= Rock Filled Yes % No 0 Water Table Depth ---4zalc--------------------------------Rock Size 4-- ------.... r _• y Distance to nearest:.Well ----/0Q---------------------':-Foundation _:/- - r-------- Prop. Line .._ .._...__•._. REPAIR/ADDITION(Prev. Sanitation Permit# --------------------------------------------- Date ------------. J------------} t t Septic Tank (Specify Requirements) ------- -----------------------------------•--------------------------- DisposalField (Specify Requirements) --------------------------•---------------------- 1- -'------------------------------------------------------------------------------- ------------------------------------------------------- -------------------------------------------------------- ----------------------------------------------------- ---------------------------- -------------------------- ----------•------------- i (Draw existing and required addition ori reverse side) I I hereby certify that I have prepared this application and that the work Iwill be done in accordance with San Joaquin County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner or licen- sed agents signature certifies the following: 4 "I certify that in the performance of the work for which this permit is issu", I shall not employ any person in such manner as to become subject to Workman's Compensation laws of California." \"r Signed ----------- ----------------------------------------------------- Owner BYTitle ------------------------------------------------------------------------ ------------- other than owner) 47 FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ---------------------------------------------------------- DATE ---------------- BUILDING PERMIT ISSUED -------- ----------- -------------------------------- DATE --------------------------------- -------- ADDITIONAL COMMENTS COMMENTS ------------------------------------ ------------------------------------------.----------------------------------------------------------------- -- ------ ------------------- .________-____________________________ _ ____ ___________�________ ___ _____.______-_-___.____________-____-____________________--_______ ____________-y____ J f_____ - O (J _ - __-_-_ Final Inspection by: = ------------- ------Date ------------------"-------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M