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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT --------------------------------- ----------------------- p Permit No. (Complete _. fes... .,, lete in Tri licate) Date issued `� �- _.__z____ri__•_ This Permit Expires 1 Year From Date Issued - •-- Application 1SQ)oeby,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 ith County Ordinance N�q 5449 and a •sting Rules and Regulations: %B ADDRESS%LOC<1TI0� r-- - --CENSUS TRACT --------------.. ---- ---------= �� 5 - -Pho Owner's Name'1-!/�-��t-------�----------�------ -------------------- •- - ------ -------- ��+7----�-•-•-----�---•- 01 Address ` � ----- - ---- city Contractor's Name ! - --- -- --------- ` Licens -, ---- Phone' �G-' �. Installation.will serve: Residence ❑Apartment House❑ Commercial Trailer Court ' Motel ❑ Other ke ?'AaNumber of living units------------- Number of bedrooms` bage Grinder ------------ Lot Size --p.��.--------------- 1 I.....y,.F Water Supply: Public System and name ---------------------- ---- ------' +-------------------------------- ---------------------------------------Private Characterrof soil to a depth of 3 feet;- Sand!❑ Silt❑ Clay ❑ Peat❑ Sandy Loam •0 Clay Loam _. „ Hardpan°❑"' Adabe ❑ 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:i (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT � { ] SEPTIC TANK Size�/•�PLX_4'_-x 19------------------- Liquid Depth -----'�_�_/-----.---------- Capacity,/9-Q_Q_---_ Typ _die--6f'Ir Material-�,r-!`, &/—±e?—No. fCompadments -----------------:_.-- fDistance :to nearest:) Well --- -- -- --------_-_-_--___---__Foundation .- ----------- Prop. Line -1 ... _-_--.. LEACHING LINE Yy No. of Lines ------/--------------- Length of each line-----SJ-------------- Total Length -------15 ' r 'D' Box.,_-____._____ Type Filter Material ! -Depth Filter Material .----le--f--------------- �______...._ € Distance to nearest: Well)0P1_F1?4_- Foundation --jPZ4 ------------- f roperty Line ____5..._..._...... SEEPAGE.PIT Depth: ______ 'Diameter r�. -�--_----_- Number --------l----------------- Rock Filled Yesx No ❑ r ,r !/ r" Water Table Depth ----------------------------------Rock Size _a- .. ---------------- rt Distance to nearest: Well ---/_'n ----------------------Foundation _ _-.___. Prop. Line ---,1 7------.-----_- + REPAIR/ADDITION(PreV."Sdnitation Permit#-------------------------------------------- Date ------------._-._--_-----_-__-_--) Septic Tank (Specify Requirements) -------------------------------------------------•- ---------- --------------------------------------------•--------------------------------- ! Disposal Field..(Specify Requirements) `" .. -"'" ----- E---- --- ----------------------t------------------------------------------- { 'S' -------------------------------------------------------------------------------------------------- -- ------------------------------------------------------------------------------------------------------ (Draw existing and required addition on reverse side) hereby certify that I have prepared this application and that the work will 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: € r"I certify that in the.perfor nce of the work for which this permit is issued, I shall not employ any person in such manner as to b e subject to o an's mp nsati.on laws of California." t < Signed ' -- ---------- -- ------ - ----------- Owner. BY ---------------------"--- ----------------- -- ----------- -- -- ---- - -- - Title (If other than owner} FOR DEPARTMENT USE ONLY F APPLICATION ACCEPTED BY ------------------------------------------------------------------- DATE ---- i ?� 9-------------- ._ BUILDING PERMIT ISSUE - -----='--------- ----------------------------- - -- ---------_-- DATE-:._"`.�------------------ -- - ----------------------- -------------- <`� ADDITIONAL COMMENTS ----------------------------------------------------------------------------------------------------------------------------------------------•--------------- ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ------- --------- i------------------------------- - ---- --- - ----------------------------------------------- ------------------ - ------------------- -- ------------------ - ---------- -- ------------------------------------------------------------- -� ------- p Final Inspection by: --------------------------------------------- -----------------------------Date - f SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M