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FOR OFFICE USE: APPLICATION FOR -SANITATION PERMIT q Y - ------------------------------------ - Permit No, (Complete in Triplicate) " - 4 Date Issued ------------------------------------------------ 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 Ordina -- a No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION -----4 /-�� If--- ------- ---- - " '`' CENSUS TRACT ---------------- --------- Owner's Name - -------- -- -------------'-- Phone Address �._ /�. i-----__ City Contractor's Name --- . "c ------<- ------- 4 ----------------------License #J6...7r_7'`7---- Phone Installation will serve: ResidenceXApartment House[] Commercial :❑Trailer Court C] - -- Motel ❑ Other7"'---------------------------------------- - -�""`� ------------------------------------------- _ /� r .. -- — _ . ,. Number of living units:___��__-__ Number of bedrooms __-Gar age Grinder �d--_-- Lot Size �---_� --�D---- _____Private � Water Supply: Public System and name`-��---- --------•- ------------------------------------------------------------•-•--- ❑ Character of soil to a depth pf 3 feet: Sand.R❑ ` Si CIE—y-0 Peak❑ Sandy Loam ,❑ Clay Loam El Hardpan dobe-[g Fill'Material ------------ If yes,type ____________________________ (Plot plan, showing vsize of lot, location of y in relationto wells, buildings, etc. must be placed on reverse side.) I NEW INSTALLATION: (No septic tank or s ge pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT �[.,]'E SEPTIC TANK Si rk__i� _�®____.__.________ Liquid Depth ._of___________________ : 'Material' W - " Ca 0ity46d_2y Type Material No. Compartments ___ .............. ` �� is nce to 'n st:'Wel �Leng r �- - ----------- ---------Foundation ---�¢----------- Prop. Line •-----4 --- i LEACHING LINE o. of Lin j_____ _ t of each line_.__- - Total Length ,__1 ..............## ',� � Box1. Ty Efilter Material 1�`----__.Depth Filter Material ___,�9_--_____________________________ istanc t n rest: I et,-, _ ��-?_�9 Foundation ___ lJ___________ Property Line ___ _______________ SEEPAGE PIT th• _�____ --------- Diamet. ________________ Number - ------------------------- Rock Filled Yes [] No .C] f Sr%P UVa e r Table Depth r ------------------ ------------Rock Size -------------------------------- �F��e Distan a to nearest: We IE ___ ________ ---------------------Foundation -------------------- Prop. Line ----- ---------------- v ------------- REPAIR/ADDITION(P V. Sanit tion Permit ------ ---""--- Date`----------------------------------) Septic Tank (Specif Requir ments) _,44di ---'J -�'�-------7-A ---'`---- i�W------S7�S%�,�---�---- mad e. } �r r'Y� -V e a�°R G e �� ' S e { Disposal Field (Spe ify R% uirementsl __L --- -- ------- -(,--o, 77~e,v Al- ,11 ---_oAn` -e-------------�'_7"�Ye_ ' v, t----..ekg �'eev el; vim' (Draw existing and required addition on reverse side) I 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: "I certify that in the performance of 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." Signedi Owner; gY � L_. --------------`-------- Title -- I (If other than owner) FOR .DEPARTMENT USE ONLY '? APPLICATIONACCEPTED BY .___7__1 - --- --- -- DATE S `' BUILDING PERMIT ISSUED ----- ---------------------------------- ---- --------------•-------------- €------------- DATE ADDITIONALCOMMENTS ------------------------------------------------------------------------------'---------------------------- ----------------------------------------•- --------- 3 e i1 ---------------------------------------------------------------------------- I------------------------------ ----------------------------- --- --- - --- _ _. ------------------------------------=- ;.--------------------•------- ---------------- - --- FinalInspection by- ------------------------------------------- ------ --------------- ----- --------------------.-Date ----------------------------------------- w w V SAN JOAQUIN LOCAL HEALTH DISTRICT -� I E. H. 9 1-'68 Rev. 5M