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FOR OFFICE USE: `' r APPLICATION FOR 35ANITATION PERMIT ------- ------------ (Cornplete in Triplicate) Permit No: - ---- --------- ---------------- ------ _.__________ This Permit Expires 1 Year From Date Issued Date Issued __ ILZ4 _�K Application is hereby made to the San Joaquin Local Health District fora permit t construct ayn the work herein described. This application is ade in comp ' rice wi Ca ty Ordi ance N 54 and ex'stingd Regulations: JOB ADDRESS/LOCATI ____ _._ .y2 ----------------- -- -- -CENSUS TRACT --------------•- --- *Owner's Name et% w/G�Q -e-�: ---- _, {__.Phone Address r Cit --- --- ------------------------=lAlf--- '�i./ mac y - Liense # -- ------------ Phone --------------------------_-- Contractor's Name __._lU__� -- ._______ ---._. c --------- __ .__�--- -.--_ - - I Installation will serve: Residence ❑Apartment House❑ Commercial ❑Trailer Court ;❑ Motel ❑Other -------------------------------------------- - �: Number of living units:-----I----- Number of bedrooms __J�______Garbage Grinder ------------ Lot Size ---------------a- ------_---.---__--- Water Supply. Public System and name ------------------------------------ --------------------------------------------------------------------------Private Z Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat❑ Sandy Loam '❑ Clay Loam ❑ �( Hardpan ❑ AdobeFill 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.) 15 NEW INSTALLATION: (No septic tank or seepage pit permit��dif public sewer is available within 200 feet,) PACKAGE TREATMENT_[ ]� SEPTIC TANK' Size______ /X_ _ Liquid Depth ____5_ 3 , - ----- ------ . .._. Capacity ._--___--_ Hype __ ___-- Material__- No. Compartments ---r . ..--... i t / r / . Distance to nearest: We ,______--JiFoundation _ 0_ `_ Prop. Line ---------- -------- f ._._ CEACHWG LINE [ No, of Anes __._�__ --- __ Length of each line 64 -�_____-- � ; _-- -____-- Total Length _ -� -. _-- De Depth Filter Material 1� �- D' Box -'A--------- Filter,,-Material - - P �--�-----------------------•----•- t Distance to, nearest: Well ____�s7___" ___ Foundation __-- -� ±t Property Line ___ __f"___-__- SEEPAGE,PIT [ ] Depth --f Diameter ---------- #Number _M_____ __ Rock Filled Yes ❑ No 0 ------------- i L4I-� ._.-Water Table epth ------------------------------------i-----------Rock Size,-- _----------------- Distance to-nearest.VlJell.._` :---- _-----=-T -----------Foundation,J:.`� -----.---- Prop. Line---------------------- REPAIRfADDITION(P.rev. Sanitation Permit# --------.______'------------------- ________ Date ________ _____________________} t",.�_ -` I 4r k Septic`Tank [Spe;i.fy,A quireme ts] ----------=----------------r--------------------------------------------------------------------------- Di posalb eld_[Specify. Requirements] i ------------------------- I-------1--111 -------------- -------------- ---------------------------------------- -(Draw'ex`sting and required addition on reverse side) I hereby certify that I have prepared,this applicati,o,n„and that the work will be done in accordance with San Joaquin County Ordinances, State Laws, and-Aules.andR Regulations of theiSon Joaquin Local Health District. Home owner or licen- sed agents signature certifies the following; I "I certify that in the performance of the work for which this permit is issued, Is hall not employ any person in such manner as to become subject to Workrnaii's Compensation laws of California.” Signed :- ---------------------- ------------ Owner B Wh- nc Y --- --- -- ---------'----------------- -Title[If othewner) �. �.r. FOR 1bEPARTMENT USE ONLY",,, APPLICATION ACCEPTED BY --------- - ------- --------------- - ------------ DATE --- S/7,1--------------------- BLT NG ADOT IDIDT ONAL OIMMENTSDt __/ L ---�--- ---- /111 p ----------------------------- -----------------------------,. `� ----- - ----------------------------- --------------------------------------- ------- ---------------------------------------------------•---- - - -- - ------------M1~' --A------------ ----- :11 Final Inspection by: .---------------! v- ----- '�" Date ------------------------------------------------------------------ - ~` SAN JOAQUIN LOCAL HEALTH- DISTRICT .. E. H. 9 1-'68 Rev. 5M