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`- FOR OFFICEg USE: , APPLICATION FOR S1ANITATION PERMIT . ------ (Complete in Triplicate) "Permit No. 64" ------ Date Issued ..__ --------- --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,4n compliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION' � .__ ----- hy_) 4 -< _ 4_____.__CENSUS TRACT -----f -------------------- �r c� Owner's Name O - N_ : _111&4-- - --------------------- -------Phone Address ------------2- �------ ...... i -L> J - Contractor's Name -----0_W E_R------------------------------------------------- --------License # ----- __.------------ --- Phone Installation will serve: Residence partment House❑ Commercial ❑Trailer Court in ` Motel ❑Other -- --- -------------------- Number --------Number of living units:____ ------ Number of bedrooms _-.__Garbage Grindei ING__--Lot Sizef-� Water Supply: Public System and name :- - -: -----_ A------------------ -- - ---. _- .s•_ -----------------------Private( � l: , Character of soil to a depth of 3 feet Sand❑ Silt❑ Clay ED-- Peat❑#<- -Sandy Loam '❑ Clay Loom. . Hardpan ❑ Adobe '❑ Fill'Material . 0-If'yes,type ---------------------------- t _. ____-__--- _ ______r (Plot plan, showing size of lot, location of system in relationtowells, buildings, etc. must be placed on reverse side.) NEW INSTALLATION: (No septic tank for seepacielpit permitted if public sewer is available within 200 feet,'' 1 PACKAGE TREATMENT [.] SEPTIC- TA�1K [ Size }; ___`?---------- Liquid Depth _..%------------------- capacity ._�-_____ 0 _< a Ca acit i�� ._ Type � Materia _ No. Com ___. __-.____.-_. l p Y F ;� yP �.Ou �� Compartments istance to nearest: Well ----------------- t_---------FOU`rlatlOn _..______� .___ Prop. Line_.--___-_ ^ � LEACHING LINE [�o. of Lines -____ _______ Length of each line"__ { ®._ Tota_ I Length 7C 'D' Box es . Type Filter Material _ f� ------ `_-Depth T'ilter Material �� v ---'----- - Distance to nearest.`'Well __ __`- } ountion-- /_�. Property Line ------ . e/ ck 12— ______.____ Rock Filled Yes ❑ SEEPAGE PIT Depth ___ �/f Diameter _ _�(__ Number ._ . ___ kNo 2 , Water Table Depth _ ------------------------ Distance ____________ __ __ ------Rock Size ........ kd i Distance to nearest: Well --------------- to ------------ :_-_=Foundation, -------16'---,___ . _'> ..__- / , - ,telProp.) Line , REPAIR DDI A (Peev. Sanitation Permit# _-_.____ ____•._ ______ . -_____ Septic T�akrr (Specify' I - Date ---------------------------------- ---------- ,Requirements) ___________________ ____ _______Requirements► ------------ - ) -:. i :. - Disposal 1.ieldf,($peafy Requirements ---------------------'--- ----- ----- --- ------- - --------------- - I-------------------------------- --- _ -" ._ __---_---`------' --- .._-- ------ -• ----_. . . _ f._ Rn -cam r- C4a (Draw existing an 'require addition"onreverse 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-Sort 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 Y as to becomersubje o Wbo man's Compensati.o s of California." 1 Signed - - -' ----- ----- ----- Owner BY - - ---------------- --------- -------------- ------------------------ Title -------------------------------- --------------------------------------- (If other than owner) W.- FOR DEPARTMENT USE,ONLY APPLICATION ACCEPTED BYt `� ----- ----- - ---- ----------------- ------- DATE __7_'. _ .�t_--- ------ s BUILDING PERMIT-ISSUED____ _ -w __ ____DATE _ _ --------- ----------------ADDITIONAL COMMENTS ___ .. ._ . '-' '�------------ ----- --- - ------ - - ---- ------------ - --------- - --- ----------------------- r -- - ---- --------------------------------------- ------------------------- - ----------------- - - - - - - ------------------------------------ In tion b _ - ._ _ ;_Date Y ------------ Final SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M g