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EOR OFFICE USE: " 2_9- 2c-�C-0-7 APPLICATION FOR SANITATION PERMIT x° 49 ------- --------- - -- -------- --------- ------------- (Complete in Triplicate) Permit No. - - , , 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 in compliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LO TION _ p -- - ��rr.��tlA,ltad�=--� ---L� -- CENSUS TRACT ----- -------------------- Owner's Name _ ._ _ _ -- Address (- � 7 --- City Contractor's Name -- - - ----- - - License # ---------------- = Phone Installation will serve: Residence ❑Apartment House❑ Comme tial ❑Trailer Court ;❑ Motel E]Other rw_'�_ _-'9 _ -- -- - Id Number of living units------------- Number of bedroo s _3----- arbage G ender -4-Lot Size -----_-_______, Water Supply: Public System and name --- ry � ---------------------- ------------------------------------------------Private _ Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat Er 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 f public sewer is ayailable within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK [ ] 2e. Siz ______________________ Liquid Depth _-�__ __________ Capacity -1,2VO------ Type �� Material-- No. Compartments - --_-Z -- , Distance to nearest: Well 1��1___,_ _ ------------- Foundation _1J__'1,Y_ _ __- Prop. Line _AD_Q_ , li! ` of LEACHING LINE [ ] No. of Lines ----�,---_________ Leng of each line.,ie �'yd ..._ Total Length _1,�.Q/_Jy�/e`fr�_i,-.._______ n ' � i/ E iF�Xm `D' Box ---!/- -- Type Filter Material --,e '---Depth Filter Material -_/_-.�---.,,--mac: ---------•----•------ Distance to nearest: Well __%tee /(__ Foundation* �.�it�,_------- Property LineD_O_ =____ SEEPAGE PIT [ j Depth --_____________ ___ Diameter _ _ _ Number __-______-_-_________ _ Rock Filled Yes Z '' No i❑ Water Table Depth _____________ Rock Size _ - e� Distance to nearest: Well SO Foundation/52/ ---- Prop. Line ___)oa REPAIR/ADDITION(Prev. Sanitation Permit# -------- ------------------------------ Date ________________________________) Septic Tank (Specify Requirements) --------______-------- Disposal Field (Specify Requirements) ---- Q------ X - --------------------------------------------------------------- - - - - -----_--=--------------------------------------------------------------------- ------------------------------------------------------------------------------------- ------------------------------- (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: �3 "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 bec a subject to Workman's Compe sati.on laws of California." Signed 1 r It-- - ---------- es �!_---- Owner By ------- - - (If other than owner) %y .DEPARTMENT USE ONLYAPPLICATION ACCEPTED BY - . DATE �a_=f.2—BUILDING PERMIT ISSUED ___ ------------ -'--------------- ,FOR ----- ---------- ---------------��-------------------------DATE ----------------------------- ADDITIONAL COMMENTS ___________________ - -• ------------------------y-------------------------------------------------------------------------------------- ------------------------------------------------ ------------------------------------------------------- --------------- -- --------------------------------------------- -------------- Final Inspection by: l - Date ' ------------------ �V SAN JOAQUIN LOCAL HEALTH DISTRICT 41�_ E. H. 9 1-'68 Rev. 5M