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j a FOR OFFICE USE: � o ,��gra! APPkICATIO .J FOR SANITATION PERMIT 1 � - i (Complete in Triplicate) Permit No. _,70-44I& 4 - --------------------------------------------------I------ Date issued ________________________._.__..._____._.____________ --- This Permit Expires 1 Year From Date Issued u 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 withC my O dinance No. 549 and existing Rules and Regulations. f r JOB ADDRESS/LOCATION .. ------ --- - - -- -- -------�------------- -----------------------CENSUS TRACT 17-------------- Owner's Name ------- ---------- - -, ------------------------------------------------------- ------------------Phone ---------------------------•-- Address --- X ell-- - ------------------------------ City - � ...------- Contractor's Name . -- --- ------------------- ----------License #/ �,1 'Phone .- --1 ------------ Installation ----- Installation will serve: Residence Apartment House❑ Commercial ❑T/railer Court ',❑ Motel ❑Otherry '----------------------------- Number of living units;--------- -_ Number of—bedrooms __L, c�arba e G - der Lot Size . F �n" � --�_ __X 2-deo -_ --------------Private Water Supply: Public System and name __ -_ - �Q __________________ El Character of soil to a depth of 3 feet: Sand"[-] Siltfl Clay-E] Peat ❑ Sandy Loam •❑ Clay Loam ❑ Hardpan ❑ AdabeFill Material _"-Z)Pf yes, type ____________________________ (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) I NEW INSTALLATION: (No septic tank oseepage pit permitted if public sewer is available within 200 feet,) s PACKAGE TREATMENT { ]I,�SEPTIC TANK'{ ] Size------------------------------------------------ Liquid Depth ----------------III . („y I L' Capacity -------�" -- " Type ------------------- Material---------- ----------. No. Compartments ------------ Distance to nearestWell ----------------------------•-------Foundation ----------------_----- Prop. Line .--.----__------------ { LEACHING LINE"y [J kNo. of Lines `:- V ------ Length of each line___________________________ Total Length ---------------------------- 1 DBox _ _- ------ Type Filter Material --------------------Depth Filter Materia! $, pistanc6-to..nearest-. Wella ----------------------- Foundation ------------------------ Property Line. ------------------._.--- SEEPAGE'PITw![R] Depth _________________--TDiameter ---------------- NumberRock Filled Yes ❑ No ] ---------------------------- P v r• Water Table Depth _�-----------------------------------------------Rock Size -------------------------------- r t. Distance to ne{rest 1Vell'+�----------_____________________ _Foundation -------------------- Prop. Line ---------------------- p , REPAIR/ADDITION(Prey.,Sani#ation P rm.it# =----- --`- ---------------------------- Date --------------- . .....----------- Septic Tank (Specify�Requirements) --- " = - --------- _ Dispo Field (Specify equirements) - -�-- - -------- - - --------- --- ------ - --- -/ -- , ' ----------------------- ---- --------------- t {Draw existing and required addition on reverse side) j I hereby°certify that 1-:.have prepared this application and that the work will be done in accordance with San Joaquin County Ordir►ances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner or ficen- sed agents signature certifies the following: "I certify that in the performance of the work for which this permit is issled, I shall not employ any person in such manner as to become subject to Workman's Compensation laws of California." S�in ed . ---------------------------------------- OwnerB . ---- _.-_ - - ._.. __ ------- "Title" .. LC} � f l f- er than owner) HENT USE ONLY AP?LIGATION ACCEPTED BY ---------------------------------------------- DATE ---- BUILDING PERMIT ISSUED ------------- ------- ------------------------ = ------------ -------`--`--DATE -------------------------------------- - - ------ - --- ADDITIONAL COMMENTS ---------- --' ------ ------------------------------------------------------------------------------=--------------------------- .r --------------- ------------------------------- _________________________________________ __ __ ___ ________ _ _ -----------_____________________________________________________________ __!_________-_______.____._________._____-____-____._. Fj Final inspection by: '' ------------------Date C = ----------- SAN AQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 ev. M