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FOR OFFICE USE: 4?PLICATION FOR SANITATION PERMIT - - ------------- ------------------------------------ ,. -Permit No. (Complete in Triplicate) - - _ 1� j� Date Issued 1__ 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 i`made in complgcg_yvith County Ordinance No. 549 and existing Rules and Regulations: .S .rY�sSTi�Yr/t'!.�/lw JOB ADDRESS/LOCATION . � En�- ��'� '� ------------------ --------CENSUS TRACT -_-______-_.. __--•--__-- Phon �`7/ Owner's Name �srorl4T--------------- ------------------ �aC_ - ..... Address W;--- -45S/J_T..W41 .--------- ------ City 47.62---, ------------------- ----- ------------------•-- Contractor's Name _./.__ A1911�-5 /1G___T ------------------------License # �Q---- Phone4 3.................... Installation will serve: Residence ❑Apartment House❑ Commercial _]Trailer Court ❑ Motel ❑Other Number of living units:-___------ Number of bedrooms ._ __.barbage Grinder __- ------ Lot Size -----�C S Water Supply: Public System and name -----------------------------------------------------------------------------------•---------------------------Priv4rte ' 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 ------------ --- --- Distance to nearest: Well ----------------------------------__Foundation __-__.__-__.___--_--- Prop. Line ---------- LEACHING LINE [L-r' No. of Lines -3---------------- Length of each line-f1012--------------- Total Length 42 'D' Box ----L-**'-- Type Filter MateriaA'5�&:._..___.Depth Filter Material _f 94'-/-------------- ........ Distance to nearest: Well /-_____-__ Foundation _�._---_--_.______ Property Line /�----------------- SEEPAGE PIT [ J Depth -------------------- Diameter ---------------- Number ---------------------------- Rock Filled Yes ❑ No C WaterTable Depth ------------------------------------------------Rock Size -------------------------------- Distance to nearest: Well ________________________________________Foundation -------------------- Prop. Line ...................... + ; REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date ----------------------------------) Septic Tank (Specify Requirements) ---------------- 7 -------------------------------/-------------------�--`J-----•------------------------------ -------E---A----C--H--/---•--------------- -------------------- �-J- ! --,L------------------------------------------------------ Disposal Field (Specify Requirements) ---. ----- ---- s sr-1►1 41-111-4- ---��'s ----------- (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: "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 Workman's Compensation laws of California." Signe ------- ------------- Owner BY ------ ------ '0.. --t/1 Title' flRriR CTX�A�!/,�---------------- (If other than o FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY -------- �----f- ?-- ------------------------------------------ ------------------- DATE - 7-7---------------- BUILDING PERMIT ISSUED ---------------------- ------------------------------ -----------------------------------------DATE ADDITIONALCOMMENTS -------------------------------------------------------------- --------------------------------------------------------------------=--------------------------- - -------------------------- - - Final Inspection b SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M