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`'AOR OFFICE USE: ' k . APPLICATIONFOR SANITATION PERMIT c .. Permit 7�/I r' ....................... '........................ P reit No. . .. ... _. ... (Complete in Triplicate) ..............•---._._._.... ............. Date issued .- U-7� ..... ... ......... ...•- ....._.....•. Tris Permit Expires t Year from Date Issued �E - Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This opolication is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: "�3 c,{' /l7 .Q-s cL .......................CENSUS TRACT I JOB�ADDRi:SS/LOCATIO ..........__,..... ..... .... ....... .... .. a Owner's Name- .U... lew._..... ��.... Phoneme,�Q�J.�.. Address ---5.�.-y.ff—..._._ -._ �l»f4' City .-.. 1+-r 4` ..._... •---•--•- �" .. -•- Contractor's Name ___6�P• /k.��. . f°v �Pte-=--•-•--•License#. 4vr7�?----- Phone ..- 4 ...........9...... a _ k �- Installation will serve:- Residence drtment House 0 Commercial JL—]Traller Court y Motel ❑Other'y � _ Number of living unit ._.___ roor Number of bedn y-_....Gdrbage Grind s er .............. Lot Size ......................... Water Supply: Public System pnd name .....----:-- ......__:___..... ............... � ____......:_Private ice/ •..._.__.....�...... ...... ...... Character of soil to a depth of 3 feet: Sand 0! Silt] Clay � peat.0 Sandy Loam 0 Clay Loam 0_� - {rV4'�Hardpan� Adobe fl l=ilt Material ............lf�yea,type............... ............ (Plot plan, showing size of lot,-iocation.af systemiri relations 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 TA14K f ] Size.................•--•• -a..._....__ Liquid ,Depth ........................... r Capacity -------------------- Type � �� `'Material......-•-----•----•... No. Compartments ., ........ t� Distance. to nearest: Well .._..}':... •-- ----....._Foundation ---_.._..............:Pea lane ... ..__... LEACHING LINE [ No: of lines .......................: Length of each line_...__...--------._..._..... Total*Length '....... ................. D' Bax Type Filter Material ....Depth .Filter Material pis#ante.t nearest: Well .... ................. Foundation --------............. ._Property.I.lne I....................... OD SEEPAGE PIT [ { ", 'Depth - "�Oiarnater L'.___.: .......Number -___-------'----• ........... Rock Filleds ❑ Na cj .a I �, . Rack INatert'Tcrble Depth .....:::-:..::�,.^^�— Size ................-f---........--- _- .. --z—Distance to nearest: Well ::: —= - -A:..= __- .... -_•, :..-.."Foundation ::.. ......:.... Prop.Aine ..... REPAIR/ADDITION(Prev. Sanitation Permit# --__- • ............................... Date .....--•---:....•_..--- ••--------I Septic Tank,,(Speci.fy Requirements) .. .. c . ..:.....-......-- --.....:_....•----•---- . .... ....._---•----------. _ / Disposal Field ! ecify Requirements) --=- .... . *.4.......... ------------------ --------------"___----__-----_____--------------_-------------. -----------._._......--•--.:.------------- •------- , !Draw existing and required addition an.reverse side! I hereby certify that I have prepared this application and that the work will be done In accordance with San Joaquin j County Ordinances, State Laws, and Rules and Rigulations of the San Joaquin Local Health:Dlstrict. Home owner or liven, ! seal agents signature certifies the following: "t certify that in the performance of the work for which this permit Is issued, I shall not employ any person In such manner as toWbecame� ct to Workman's Compensation laws of CaIIfarnia." Signe .......... ... - `f � Owner{ ....---•--By --- her an a nerl _ �d EPARTMENT USE ONLY APPLICATION ACCEPTED BY -•---- --- ----•-••-•--------------------I........., DATE BUILDING PERMIT ISSUED ---•-•----• ----------------------------------------------- ------• •--- .............DATE _ ADDITIONALCOMMENTS ------------------------------------ ....... --------•----•-- ----•_. ------ .......-__-_.....................................:............... -----•----- ----- -- -- - : _. . ... Final Inspection b -____-Date .... '' �- P y: ................... . -._.--_-------=•_----•-•-- �� `�b� EH 13 24 1-68 Rev. 5M SAN JOAQUIN .LOCAL HEALTH DISTRICT 8/74 - 3m