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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT --------------------------------------------------------- Permit No. -------- ------ -- . (Complete in Triplicate) A------- ----------- y Date Issued X°'n 7 ---------------------------------- ------------------ 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 Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATI N .__lG�l � { =� �-- /L� CENSUS TRACT --- Owner's Name ------ - -O�-Q-_Z�. - - =�'-L�� :��t.. .<-------- - - - ��-------------Phone -------- ------------ Address Jt t -�' - - City -t d - Contractor's Name ------ L*t r- li - - L `-license# -1--1- -,�_k_yPhone -------------------------••--- Installation will serve: Residence Apartment ouse❑ Commercial ❑Trailer Court i❑ Motel ❑ Other _-__ __— - - �`' Number of living units_____________ Number of bedrooms ______ .___Garbage Grinder __________- Lot Size ------------------------------ Water ____-_-__________________Water Supply: Public System and name ------------------------------------ --------------------------------------- - ------------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 sees ge pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT { ] SEPTIC ITANK'[ jY Size_c - _X_�_ _f 1�_- _�_ _«_____._ Liquid Depth SZ��______________ Capacity - /�_P r__ _ Type _ �_�- 0--t)Material___ v--N------ No. Compartments ___ �,. ......... k-1 Distance to neares Well -------LP_C'___--•_______________Foundation ____10-1-------- Prop. Line ----- ........ LEACHING LINE [Jr/No. of Li sg ( g ___-___�_____________ Length of each line-______�_(_7__�'____--_____ Total Length ----J-b_Ci....y------- 'D' Box - __ - ___ Type Filter Material ___ , -_-___Depth Filter Material ____�__�Z___-______________ __________ �. sDistance nearest: Well ______�__��________ Foundation ________�E?____._____ Property Line. ________________________ SEEPAGE PIT [ j Depth -------------------- Diameter _______________ Number ------ Rock Filled Yes ❑ No Water Table Depth -------------------------------------Rock Size -------------------------------- Distance to nearest: Well _______________________-_________--Foundation ___________________ Prop. Line ...................... REPAIR/ADDITION(Prev. Sanitation Permit# ____________________________________________ Date ----------------------------------) Septic Tank (Specify Requirements) --------------------------------------------------------------------------- --------------------- -------------------------------•- Disposal Field (Specify Requirements) vx.__ <c '_ `-`_- "'-- - -- _ o C--Kwl�_ ---------=`- ____.�'------- E-=�=-- -- --- -- --` t - --------------------------- --�t -'` , .? '� `! '� = 'y �. ---- Vis'(�.. -�-� ------------------------------------------------------------------- (Draw existing and requir ad2Yition oK revue 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: "1 certify that in the performance of the work for which this permit is issued, I shall not employ any person in such manner as to become subject to Wor n's Compensation laws of California." Signed ------------------------------=- - -------------- Owner _ �c e,.�—�_ ''�"t`��' --- rte 2_e--' BY -- -------- ---------------------------------------------------- Title ----------------------------------------------------------------------- (if other than owner) F lt DEPARTMENT USE ONLY APPLICATION ACCEPTED BY -7 Vit`t Jam, - - DATE = - 7 ----- BUILDING PERMIT ISSUED ----------------------------------------------------------------- --DATE ------------•------------------ ADDITIONALCOMMENTS --------------------------------------------------- -------- --------------------------------------------------------------- -------------------------------- ----------------------------------------------------------------------------------------------------------------------------------------------------------------------•---------------------------------- -------------------------------------------- -------- --- ------ - ------------- --- ----- --------------------------------- ---- ----- -- - - - ----- -------------------------------------------- -- -- ---- ------ - -- ------ -- -- -- Final Inspection by: `-� ._ - Date - `1= 7 SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M