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FOR.OFFICE USE: o-a / / t APPLICATION FOR SANITATION PERMIT ------ - ------------ )k (Complete in Triplicate) Permit No. ----------------- r � 4?3_( Date Issued ________".______.-.-' �� [o------------------- 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 Or finance No. 549 and existing Rules and Regulations: CENSUS TRACT JOB ADDRESS/LOCATIONnn._- Owner's Name K — t---- t-------- Phone ��__�.�-�__-------�`. Address . %� it ty _ ------.License # /��d��,5 /1--- Phone Y�IQ o7 Contractor's Name ---------------- - - - ---------------------------------- Installation will serve: Residence KApartment House❑ Commercial ❑Trailer Court ❑ Motel ❑Other ----------------------------------- ------- Number of living units:________ Number of bedrooms .�_-___Garbage Grinder ---Nj9__ Lot Size __� _�C---/5 ------------- A Water Supply: Public System and name ------------------- -- .(it ��-------------Private ❑ Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam;❑ Hardpan ❑ Adobe 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: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK'[ ] Size----------------------------------- Liquid Depth ----------------.--_------ 1�\ Capacity ----- ------------ Type -------------------- Material-------------------- No. Compartments ---------------•---- Q Distance to nearest: Well ___________________________________Foundation ---------------------- Prop. Line ___-____.-_-._,------- LEACHING LINE No. of Lines CI-)-------.__ Length of each firleA49 .4-- Total Length `�S.tk1.1lI 0..._.._ 'D' Box CV)--- Type Filter Material Depth Filter Material ---[-_ -__ _______.______-_-__-.,_..------ Distance to nearest: Well _______________________ Foundation ------------------------ Property Line _____-______----_-- _-- SEEPAGE PIT 1 Q Depth _-�_0--___ -_ Diameter ________________ Number -------- ------------- __(_�Rock Filled Yes A No 0 j ,( Z ;• x Water Table Depth ------------------------------------------------Rock Size ---` ------- -------------- n Distance to nearest: Well __ ?'t- � --------------Foundation _.. ____-____ Prop. Line _16 --------- REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date _____ -----------If----- ---) Septic Tank (Specify Requirements) ------------ :w45_-2-.�----- .......... ---------------------------------•------ Disposal Field (Specify Requirements) ----- _X -X- -- - -'---- -- -- --------- ! ----------- ------------------------------------------------------------------------------------------------------_•---------------------------------------------------------------------------- - (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 certifyA:inthnormance of the work for which this permit is issued, 1 shall not employ any person in such manner as to becgrkm s Compensatio aws of California." Signed -- ----- - ---- --------- ------------ OwnerBY - Title - - --- -- - ----- - -- - dzQ n owner) PARTMENT USE ONLY APPLICATION ACCEPTED BY ------ - ------------------------------------------------------ DATE ------�=. .— 17--------- BUILDING PERMIT ISSUED ------- -- ------ -------- --- - -------------------------------DATE --- ADDITIONALCOMMENTS ------ - -- - -- -- --------------------------------------------------------------------------------------- ------------------------------------------------ ----- ------- - ------------------------------------------------- ------------------------------------------------- ---------------------------------------------- ----- -- ---- -------------------------------------------------------------------------- - - ---= ------------------ ------------------ ------- ,�-_ _ FinalInspection by: ------------ - ----- -- --- --- - ------------------------------•---------------------------------------.Date ------� N OAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M