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FOR OFFICE USE: ----------------- _ ---_______ APPLICATIGN FOR SANITATION ;ERMIT rr Permit No. (Complete in Triplicate) � --- ------------- - - - --- --------------- �j Date Issued _______-- This Permit Expires 1 Year From Date Issued f 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 w'th County Ordinance No. 549 and existing Rules and Regulations: / ri rte_ CEN S TRACT _ -_-_s�"_3.�.-. JOB ADDRESS/LOCATION•: W _ ✓ _Fd- ---C J� � _. .��rL �� Owner's Name - ~� �' ✓-c?�z C-------- - one 2" 1 Address --------Y' ' r 3 ----------------------------------_. City � TOy'✓ Contractor's Name ------------ --------e,4/1 --------------------------------------------------License # ------------------------ Phone ------t% Installation will serve: Residence E] Apartment House❑ Commercial Trailer Court ;❑ d i/ C 4rY - Motel ❑ Other __ ----------------------------------------- yG 2-- Number of living units:______ ____ Number of bedrooms ._t---Garbage Grinder __-------- Lot Size . - _ -- ----i`----------------------- Water Supply: Public Syst and name ------------ _--•----------------------------------------------------------- Private ❑ Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat K 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 fpet,) ion PACKAGE TREATMENT [ ] SEPTIC TANK,[ ] Size______________------___---------------------- Liquid Depth -_-___--.-_-_-.__----_9 Capacity ------------------- Type ------------------- Material--------------------- No. Compartments -----------------•----f+ Distance to nearest: Well ------------------------------------Foundation ---------------------- Prop. Line ----------_---------- LEACHING --------- -.--_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 ------------------------\/► Ar SEEPAGE PIT [ ] Depth -------------------- Diameter ---------------- Number -_______ ---------------- Rock Filled Yes ❑ No i❑A WaterTable Depth ------------------------------------------------Rock Size -------------------------------- Distance to nearest: Well ----------------------------------------Foundation -------------------- Prop. Line --------------------_. REPAIR/ADDITION(Prev. Sanitation Per # .--_--_ ----------------------------------- Date ----__---____---------_______-----) Septic Tank (Specify Requirements) i SYNC � ,� �,�. . ---_- ------- Disposal Field (Specify Requirement 4 - ------ � ---- ------------------------------------------------------------ _ _ (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 subject to Workman's Compensation laws of California." Signed - -------------t-------- - --------------- Owner ------------ Title BY 3 -- - r------------------------------ (If other than own r) F DEPARTMENT USE ONLY APPLICATION ACCEPTED BY - .' `q*f' ----==e�',7------------ -----------. DATE ---=-Z_._ `3 r��---------- BUILDING PERMIT ISSUED ----------- -- - DA E -------- ----- ------ ADDITjIaONAI,,COMMyNTS - -V-7V /yr_��j -W _ -----y_ _--�----- ^✓` _ ----- _ to f!_4"_ - - ---- --- --"-� -- - --- - --- 1 ►�-"Z - ------- --- i------------------------ ------------------------------------------ ------------ - ---- ---------------------------------- - - - - - - - ------------- -- ----------------------------------------------------------------------------------- - -- - - -- - --- ------ - ---- Final Inspection b - --------------------- _ _ _________ _ _ _____-_______-___Date /Q_-__7 SAN JOAQUIN LOCAL HEALTH DISTRICT" r E. H. 9 1-'68 Rev. 5M �''�