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� FOR OFFICE USE: � -�. ,�� ._._,--�----•- _ _.._ '� __ _.- — - ---_ --------------------- APPLICATION FOR SANITATION PERMIT I___ (Complete in Triplicate) Permit No: ------------------------- ---- _ l This Permit Expires I Year From Date Issued Date Issued Application is her madel�to the San Joaquin Local Health District for a permit to construct described. This application is made in compliance with?County Ordinance No. 5 l and install the work herein JOB ADDRESS/LOCATION ! - 49 and existing Rules and Regulations: ---- � Owner's Name ----------- ------------------------CENSUS TRACT -- -------- ------- -- ------ 7 Address ----------------------------- ---- one ^----------------------------- --_"'moi :-_. E t,, 7 Contractor's Name `{-�` y_�r - _ - - + Installation will serve: - - -- ----License # 1*< Phone Residence El Apartment House❑ Commercial:❑Trailer Court ;❑ Mote! ❑Other_ Numb Number of living units: a•- V"n -- '-•- Number of bedrooms .________.- Water Supply:'Public System and Warne r- '-4iYy -C'arbage Grinder __ ` "> --v. LoT Size — ---x---70 i ....x- ._ ------- Character of soil to a depth of.3 feet: Sand L j I Sil i .t E s.:.; ?�•�--- Private { ` �•,�❑ Clay [] �P�{❑• Sandy Loam � Clay Lopm [� II Hardpan [] Adobe ` Fill Mater ---------------- ia( _ ___,1 ifes ! Y type ------ (Plot plan, showing size of folt, location of system in relation to wells, buildings, etc. must be laced o i NEW INSTALLATION: � - (No septic tank ar seepage pit p emitted�ii public sever is available within 200 feet,) reverse side.} PACKAGE TREATMENT [ ] SEPTIC TANK j ] 1 Size ------------------------- Liquid Depth -------------------- III -------- . Capacity --------------------- T - ----------- al , No. Compartments -. ------ ------ P _ DistantMe to nearest: Well r4 v ' ----------------- 1 --- Material LEACHING LINE - ,-F�iatlon----__---------- Prop. Line -.---•-•--.--- ] No. of Lines ------------------------ Length-of ioUi line._____---_ - -- t 'D' Box ------------ , E----- Total Length Type Filter Material ------------- ---•--------------- -------Depth Filter Material ----- - -- 11 i Distance to nearestr�Welf�--'---------- ------ f - - -----------------•-••-----•---•-•- r SEEP ] Depth �I_ { ---- Foundation ------------------------ Property Line --------------- Water _ __-- •-- - la meter ------------ ----- Number ------------------------ Rock Filled Yes Water able Depth F"=� ----------- ' ❑ No . I ( ` ��------- --------------------------Rock Size Distance to nearest: Wel! -__-" Foundation ---- f Prop.(Prev. Sanitation Permi �__.""` ��- t ' is.�i Prop. Line ..... -------- Date ----- Septic Tank (Specify Requirements) _ "'�'~--�--° _ .-----------} C i ------------ --------------------- Disposal Field {Specify Requirements) --------_. ---- -------- I I I cr``------ ------------------ I ------------------------------------- ----------------------------------------------- ------------------------------------ ------------ (Draw existing and required addition onsreverse side} 1 hereby certify that 1 have prepll red_ this application and thptJthe"—* County Ordinances, State Laws, andw6irk`-'will be dne in Rules and Regulations of the San Joaquin LocalQHealth District. Home owner or 1 ceance with Son Joaqun sed agents signature certifies the following : "1 certify that in the performance;1of the work for which this permit is issued, I shall not employ any person in such manner as to become subject to Workman's Compensation laws of California." Signed 1f - _._ . { 1- -- ----------------- --------------------. Owner BY ---------- (if t er than owner} - ------------------------------------------------ title ------ - II FOR;DEPARTM-ENT USE ONLY F APPLICATION ACCEPTED BY______U3.6% BUILDING PERMIT ISSUED __---------! -- - ----------------------- -------------------- ----- -------•---. DATE �^..Z-^ 7 Z ADDITIONAL COMMENTS _--------- i(_._ ------ -- -- -- -------- ------------------ E ----- -------------------------- ------------------------------------------- ----- i -- ------------- ----------------------------------------------------------------------------------------------------------- --•--------------------------- ------------------------------------------------------------------------------------- FinalInspec b ++..'' -! ------------------------------------------------------------------------------------------ P Y u11elcy�-------------------- ------------------------------------------------------------------ .Dated~_� �.�.�------------..__ ---- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M