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I w FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT " Permit No. 0 (Complete in Triplicate) '°� Date Issued------- --------- -- --- - -------------------- V ---__-.__-_"------__--- This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Health District foraa permit to construct and install the work herein described. This application is made in,compliance with County Ordinance No. 549 and existing Rul s and Regulations: JOB ADDRESS/LOCATION TRACT -------------------------- 15� --- ------------------------------ ----=- ----------- -------Phone ------------------------- --------- Owner's Name Address 1`-f`-----�y a. l ------------------------------------------ City - ------------------- -----�-----J-- -•- - Contractor's Name --------------------------------------------------------------------------------------- #AKf ?>F'_2-_ ";405/_ Phone/4 Installation will serve: Residence *artment'H6use,0 Commercial ❑Traile"r Court l❑ Motel ❑ Other --------- ------ ---------------------- ""R Number of living units:___ ..... Number of bedrooms __5------Garbage Grinder - Lot Size 4�� ------------------ v n, Water Supply: Public System and name -------------------------------------------c -� --1------------------•------------------------------- _______Private� Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑fit Peat❑ Sandy Loam ❑ Clay Loam ❑ 0.-' # + k Hardpan ❑ Adobe Fill Material --'_.______ If yes,type ____________________________ e (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,) .e /. [ Z Size--- ------------ Liquid Depth I! PACKAGE TREATMENT SEPTIC TANK [,RGG�� -�--��--- y,--- ---------"- Capacity/_____�&P---- Typed a / Material_�L�/ ...-- No. Compartments tel, Distance to nearest: Well __ ��~ -----------------Foundation _`off_._�______ Prop. Line ._4P_42. ------- ,r � ` t LEACHING LINE {!.}-' No. of Lines ---A------------=--- Length of each line----�s�-�--- ----- Total Length _ ---•-------- / De ------- Depth Filter Material / --- 0 'D' Bo;xe_ _Q _ Type Filter Material/ 1 p f 1 --- Dis11 tan to nearest: Well ----��__-- ep -.______ Foundation _��e _.____�Property Line _'ff ------------- to SEEPAGE PIT [ ] ,Depth _/��_-----_ ___ Diameter ! ,�'�-_v____ Number --- Rock Rock Filled Yes No �j' • �,..�..�.�.�...--Water_Table.Depth.----� -----------------------------------Rock Size/_,:� Distance to nearest: Well ___ ______-{_ �F_____--Foundation 0/- Prop. Line _ p__.._...-_ ,• Date -------- -------------------- I ----- -- REPAIR/ADDITION(Priv"Sanitation'Permit#':___'._ �_�""_____�____ -------------ti--1 Septic Tank (Specify Requirements) 4 = ti = . --------------------------- _ ri . Disposal Field (Specify Requirement ---------------=--------------------------------- ------------------.:----------------- --------------;------------------------ --------------------------------------------------------------=------- -----------------------------=- --------"---------------------------------------- ------------------------ ------------------------ '�' � � - --------------------------------------- --- -------- --- ----- [Draw existing and req b fired additio- 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 y t` "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 -----------------------�- -- -------------- ----------------__Owner By ------------�---- r Title --- FOR-DEPARTMENT ------ 1Z ---�---------- ---------- � (If other th owner) FOR-DEPARTMENT USE ONLY f ` APPLICATION ACCEPTED BY __-- ------- f`-_____-----. DATE ----�:._ �-qi---------------- ------------------------------------------------------------ BUILDING PERMIT ISSUED ----- ------------------------------------------------------------------ t DATE - ADDITIONALCOMMENTS --------------------------------------------------------------------------------1----------------------------- -------------------------------- --------- ----------=-------------------- ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ------- ---------- --- -------------------------------- ------------------------------ s ----------------------------------------------------------------------------------- - ------------------------ ---------------- - ----------------------------- �� Final Inspection by: -- - Date SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M ; *4