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FOR OFFICE USE: WAppLICATION FOR SANITATION PERMIT `/ Permit No. l- -------- - ------ (Complete in Triplicate) '< Date Issued ..✓_-�.-_i<° -. -------------------- 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 compli nce wit .County Ordinance o. 549 and existing Rules and Regulations: r. JOB ADDRESS/LOCAT 'N). ------------� -- CENSUS TRACT t� ` ------------- - Owner's Name ---�-------- -------- =V---1.�..----------�'T---------------------------- � - ------Phone��-%Z--=•�-`J_C_ ----------- Address G --- ---- --_- •--. Citi'`' - ----- --- - -- Contractor's Name '- t -- t, = i .License # . � d c?1y� Phone Installation will serve: Rersidence partment House❑ Commercial ❑Trailer Court !❑ Motel ❑Other ----- ----------------------- -------------- Number of living units------------- Number of bedro -Ga a Grin er --___-._-__ Lot Size -_ .._ ------1___ yrs Private Water Supply: Public System and name ------------�_ " --, � ❑ 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 --------..-.-.------.-.--. Capacity -------------------- Type ------ Material---------------------- No. Compartments ----- ............ 1 Distance to nearest: Well ------------------ -----------..----Foundation ---------------------- Prop. Line --------._,..;_----- LEACHING LINE [ ] No. of Lines - ------------------- Length of each line_._-_-_--_-_---_-_._---- Total Length ,-.--...._----------------- 'D' Box ------------ Type Filter Material --------------------Depth Filter Material -------------------- ----------------------- Distance to nearest: Well ------------------------ Foundation --------------- -------- Property Line ----.----._-----_---. SEEPAGE PIT [ ] Depth -------------------- Diameter ---------------- Number -.-------------------------- Rock Filled Yes 'Q No 0 WaterTable Depth ------------------------------------------------Rock Size -------------------------------- Distance to nearest: Well ----------------------------------------Foundation -------------------- Prop. Line ...................... REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date ----.--.---.--..----.-.._____----_) Septic Tank (Specify Requirements) --------------- :.------------------------------ ----- - - ----- - -----•-•- Disposal Field (Specify Re 'rerrie ) --------- ------ --LtEZ'�cJ ------- --------- -- --------------- 1 ---------------/- �-,.3- -------------------------------------------------------------------------------- ----------------•------------------------------------------------------------------------------ (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 i h perforipance of the work for which this permit is issued, I shall not employ any person in such manner as bec ub' iv-Wo an's Pen w--- 'California." ---------- -'--.Signe, ------ Ow ner --------- Title ----------------------------------- ------------------------------------ (If other than owner) / FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ----------- ----------------------------------------------------------------------------- DATE -- 6- ------ ---- - --- BUILDING PERMIT ISSUED --------------- ------- ------- - s D TE --- ------------ i �LEe d� Ea� .G� Gia, t Prw ADDITIONAL COMMENTS _/ -_7_Al.___.-. -------------------------------------------------------------- ---- --? ,•�,�� ----- ... ---------------- ---` 1 ---- ----- ----------------------- - - - -- - --- - - ----- - - - - ----- --------------- - -- --- - 1 . Date � --(-- ----- ---------- ----------- --- - --- - -- - - Final Inspection by ��,(, ��_____ _ __ _ _________________ ----------------------------------- -- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M