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FOR OFFICE USE: d d - APPLICATION FOR SANITATION PERMIT - C/C S Permit No. ------------ CI (Complete in Triplicate) _.) -�_;. ----------------- Thus.Permit Expiret 1 Year From Date Issued 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 Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION -2-M-1------- a+e7_;1- - ------------------------ ------------------CENSUS -BRACT =------------- --------• Owner's Name ----�.��--�.� , -------------------Phone ------------------------------------ Address ----- -„3--.�.--------- ,Cr”"�y '---------------------------------..... City ----------------------•-------•------ Contractor's N rrne - License# � t-Phone Installation wild serve: Re'si`dence [Apartment House,Q'Commercial ❑Traile Court 0Motel F]Other ------------------------------------------- Number of living units:_______ Number of bedrooms -13, Grinder _ _ Lot Size Water Supply: Public System and name � '��- --------------------------------Private ❑ Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Gay ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ Hardpan (_] Adobe & Fill Material _ If yes, type ----------------------------- (Plot ____ ______ __ _______(Plot plan, showing size of lot, location of system in're&tion to wells, buildings, etc. must be placed on reverse side.) VI NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) \ F ' �� 4 \ PACKAGE TREATMENT [ ] SEPTIC TANK f Size_�)C__�j_. ---- -_ . _____ Liquid Depth 4 ------------------ Capacity /_Z_V,�/_,__-Types ' No. Compartments _ -%. .... ... Distance to nearest: Well ------------------------------------Foundation L- -____-_.__ Prop. Line -------- LEACHING LINE No. of Lines ___. ____________ Length of each line- � � � Total Length -4- ---------- oe'D' Box 4/0-5 Type Filter Materiat'1/ .41; _Depth Filter Material ____._..______________________ __________ 10 Distance to nearest: Well ---- ---—------------ Foundation ............... Property Line SEEPAGE PIT Depth __ _, �f____ Diameter _ _��. Number __�-- _-:___-_- Rock Filled Yesee KNo 0Water Table Depth __ ____ _. sE -- .�---------------------------------Rock Size ,�-�="-�------------.- Distance to nearest: Well ___--__._� — ____________________Foundation ------ Prop. Line --__ s .. REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date __-_______-_______--__-___-,______) Septic Tank (Specify Requirements) ------------------ ----------------------------------------------------------------•-------------------------.-------------- ------------ Disposal ------------ rDisposal Field (Specify Requirements) -------------------------------------------------------------------------------------------------------------------- --------------- --------- --------------------------------------------------- ----------------- ------------------------------------------------------------------------------------------- (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, 1 shall not employ any person in such manner as to become subject to Workman's Compensatiq7 laws of California." Signed -------------------------- - G ------------------ Owner i BY --------------------------- -4 -------- ��G 4---------------- Title .--- �� --------------------------------- --- --a w (If other an owner) ---------------------------- FOR DEPARTMENT USE ONLY APPLICATION AC EPTED BY __ _ DATE7,2 __ BUILDING PERMIT ISSUED ---- --------- - --------------------------------------------- .._DATE -------- -------- -------- --------- ADDITIONAL COMMENTS _ ----------------------------------------------------------------------------------------------------- -------------------------------------------------------------------------------------------------- --------------- -------------------------------------------------------------------------------------------------- --------------- ------ ------------------- ------------------------------- - ------- -- ------ ---- - ---- - -- --- - - - 2-- - --- ------ - - -- --- _i.-- -------- Final Inspection by: -� a..,.' -•--- -- ------------- Date / ` SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M