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FOR OFF!CE USE: APPLICATION FOR SANITATION PERMIT / (Complete in Triplicate) ermit No. P . ---- . ----------------- --_-- .----____-__-__-- This Permit Expires 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/LOCATIONs' - - - ----------------- CENSUS TRACT Owner's Name -- LZ'�_" = - *1dZ71P 5e ------------------------------------------------------ - Phone ` J_ ,�rc4f C Address ----- zn- z Y ' --- a ��- --- -- ------- ---- City ------- T_� `Z-- --------- ----- - -------------------------------- Contractor's Name c4_�----------------------------------------------------.License # ----------------------- Phone ------------------------------ Installation will serve: Residence M Apartment House,❑ Commercial ❑Trailer Court ;❑ Motel ❑Other / Number of living units:---- Number of bedrooms _"Z__----Garbage Grinder _-�__-_ Lot Size __?.__ `2S - ------------------ Water Supply: Public System and name __-___--- S+.C��, �r, T�/� SC—/�'!� �'� ------------------------------------------�--- --_----- ------------------------------Private ❑ Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam '❑ Hardpan ❑ Adobe X Fill Material ------------ If yes,type -.._.______________________ a (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 PQ Size_ 4/t_''. _-._ —�-^ __-_--_--__- Liquid Depth _____________________-___ Capacity ------------------- Type ------------- ------ Material'-��' '�o. Compartments -----2�---------- Distance to nearest: Well __�_'v1��`---___-__-Foundation��__�--______- Prop. Line _________________---- LEACHING LINE [� No. of Lines _____-_�_-_-___- Length of each line---------1-( 1_-_____ Total Length -__&��-r_-_._.._ r� r 'D' Box ____�------ Type Filter Material _t,,:___a9c�cpepth Filter Material .__-_.___-________________________________ Distance to nearest: Well `7_.523------__- Foundation Property Line 7. SEEPAGE PIT [vT Depth __ -i__l-___ Diameter _ rr-- Number --------------y __-__- Rock Filled Yes 0;o,' No i❑ Water Table Depth ------------------------------------------------Rock Size ----------------------- -------- Distance to nearest: Well __�7..(00_t--------------------Foundation ___--__-____ ------ Prop. Line .--__-__•---______---_ REPAIR/ADDITION(Prev. Sanitation Permit# ___ Date Septic Tank (Specify Requirements) -------------------------- Disposal ___________-____Disposal 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, I shall not employ any person in such manner as to become subjec to W rkman's Compensation laws of California." Signed __ -- -------------- , � --------- -------------------------------------- Owner By -- ------------------------------------------------------------------------------------------------ Title --------------------- --------------------- - (If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BYt ----- - - DATEd " !S;-- 7 `� BUILDING PERMIT ISSUED --------------------------- -------- --- -----------------------------------------------------------DATE - ---------------------------------------- ADDITIONAL COMMENTS ------------ ------------------------ �' 1 --------------------- - - - ----------------------------------- c I ina Inspection b - P Y' - � T----------------------------- --- --------------Date ------- I �� - - - - -------------- - SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M