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FOR OFFICE USE--. APPLICATION FOR SANITATION PERMIT Permit Na. lz-------------------- (Complete in Triplicate) Date Issued,M0------------------------ # 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 Regulation 131 --CENSUS TRACT ------,1 •---- JOB ADDRESS/LOCATION .- - - - ------------- --------------------- -- -- - - ---- - - _ �_ 6-0 ----------------------------------------------------------- - Phone ----D " ' Owner's Name -___ - - -�, Cit M-- -------------------------------------------- Address ®® __rte'-� ------ -��pf--- �--ap------------- ------------ ---------------•- - Y ------ ------ -- -- Contractor's Name License # 71 - �_ Phone ------------------------------ Installation will serve: Residence [Apartment House❑ Commercial ❑Trailer Court ;❑ Motel ❑Other --_ - ' ------------------------------ ----- - - Number of living units:_- ___ Number of bedrooms ------------Garbage Grinder,.,-------- Lot Size --___- __ __---------------------- Water Supply: Public System and name _- --------------------------------------------------------------I , and Loam ___ Character of soil to a depth of 3 feet: Sand'o Silt Clay E] Peat E-1r Sandy ❑ Clay Loam ❑ Hardpan ❑ Adobe ❑ Fill Material --------- -- if yes,type ---------------------------- [Plot plan, showing size. of lot, location of system i relation to wells, buildingsF etc, must be placed on reverse side.) } NEW INSTALLATION: (No septic tank or seep pit permitted if public sewer is available within 200 feet,) r c ------------ PACKAGE TREATMENT [ ] SEPTIC TANK'f Size------- Ix __-____ ______ ------ Liquid Liquid Depth ______ _ 0 fi 7 /��,r�[�� CZstance �ty�XA 5-- Type _j_4V8� Material__�N No. +Compar#ments ---------2,. t; f to nearest: Well ____-1Q-0---��_--------•Foundation -----/V Prop. Line _____---_'S LEACHING LINE No. of Lines __._-- �_ g ____ Total Len Len th'of each line Length -------z- i' 5 Type Filter Material __} (l_G��` --- -------------bepth Filter Material ----- -�- •-----•------- 'D' Box s Distance to nearest: Well ______ Foundation Property Line ____-___-_---___. �1 :SEEPAGE PIT- [ ] Depth -------------------- Diameter ---------------- Number -----------,----=----------- Rock Filled Yes '❑ No ❑ . .`.. Water Table Depth ------------------------------------------------Rock Size --------------------•---- -•--- Distance to nearest: Well ------- -----------•-------•------------Foundation --------------------- Prop. Line _...---....---•_:----• ., REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date ----------------------------------1 -- -- Septic Tank {Specify Requirements) -- ----- -------J ----------------- ---------------- ---------------------r� - 1�7 Z11 Disposal Fieldy�(Specify Requirements) -----------h g�------ ---�'-�--------------- ---------------------------------------------------------- ;0 ----- - w�D� _--- - `---------------------'-_i---------------------- - ---------------..r._a -�_-- .-_. -,- __=� _-- - �._-_� �^-"_• - ----- z r ------------------------ = .L ----------------------------------------------------------------------------------------------------------- k (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 .y ,.,County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner or liven- seda gents signature certifies the foil ing: certify,Rthat in a performnc ' f t e work for which this permit is issued, I shall not employ any person in such manner 1 . ' as to becom u lett to W:ffno�pensa ion laws of California." Signed ------------- -------------------- - - -------------------------------------------------------- Owner BY -------------------------------------- ----- ----------------------------- ------------------------------.Title ------ ------------- ----------------------------------------- - - (If other than owner) { FOR .DEPARTMENT USE ONLY 7 ` APPLICATION ACCEPTED BY t------- DATE r ��/f ------------------------------------------------------- -------- `i BUILDING PERMIT ISSUED --- ---=-- - -------DATE ------------------------------------------- ---------------------------------- t ADDITIONAL COMMENTS ------ -- I ------------- -----------=-------------------.-•----- ------ - --------------------- ---------- ----- - --------------- ------ ----------- ---------- --------- ----------------------------------- ------------------------------- - --- -- ------------------ ------------------ --------- -- - ---- -- -------------- ----- -�' ... 7J�-y Final Inspection Y = _ -------------------------Date - ------------------ -------- `� ----- --- ---- SAN JOAQUIN LOCAL HEALTH DISTRICT : E. H. 9 1-'68 Rev. 5M