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FOR OFFICE USE: APPLICATIOW FOR SANITATION PERMIT ------- - ------------=---- ----------------------- __�?_Y-Jl.�� (Complete in Triplicate) Permit No: This Permit Expires T Year From Date Issued Date Issued ---ff ll 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: I q JOB ADDRESS/LOCATION -------- / -----)FE . �.0 I;— _�.. T -------CENSUS TRACT -------------�---•-•_-- Owner's N/amQe -------Z A----� b/ 1 Phone !` Address / / ` ` . I �--------- Cit. Contractor's Name ._____.License # _ _ /_+ Phone _:_ `� . Installation will serve: Residence Apartment Housef] Commercial:❑Trailer Court ❑ Motel NOther -QVy----_7/44_f_-• &10P Number of living units:------------ Number of bedrooms ----------..Garbage Grinder ------------ Lot Size 'Ie- a9 _ ________________ Water Supply: Public System and name ---------------------------------------------------------------------------------------------•-----------------Private ) Character of soil to a depth of 3 feet: Sand' Silt❑ Clay [I Peat El Sandy Loam .❑ Clay Loam 1E]i T ' k Hardpa ❑ Adobe'❑ Fill Material _ __a---- 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 seep pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT { ] SEPTIC TANK [ Size___ __-___-. _ - '� squid Depth ^ Capacity _Crts1-d__------ Type -j - - Gyaterial_ a. Compartments __ _f----- f Distance to. nearest: Well -----C_0_____________________Foundation ___..l d_--_______- Prop. Line A� t-�____:________ q ; LEACHING LINE /""'No. of Lines --------�__-_--__-___ Length of each line---_--�__----------- Total Length ____6---d________________ -i . .. 1. y� D' Box°------ Type Filter Material MP.&-k-----Depth Filter Material ----l 5F _________ Distance to'nearest: Well __6P >a 7 -----_---- Foundation ----- ---- Property Line. --�--•.---------:._._ 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 ______,___A_-_______.._-________) Septic Tank (Specify Requirements) ---------------------------------------------------------------------------------- ---------------------------- Disposal --------------------------Disposal Field (Specify Requirements) -------tfl)_(;N_E�!5t7---------6---- -- fl --------------------—----------------------------- -----------------------: ------------_ (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 Son Joaquin Local Health District. Home owner or licen- sed agents signature certifies the foil ' ing: "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 Work m 's Compensation laws.of California." Signed ----- --- -- -- f------------ Owner i By -------- --- Title ----------------------------------------------------------------------- (if of er than owner) VVV FOR .DEPARTMENT USE ONLY APPLICATION ACCEPTED BY _-.--�y._R_"0------------------ --------------------------------------------------------- RATE ----9-_/_ -`-6-- --- BUILDING PERMIT ISSUED = ---------------------•--------- --------------DATE ------ ------•------- ADDITIONAL COMMENTS -------------- - i ------------ ------------------------------------- - --------- - -- ---------------- - ------- ii ---- . { --------Date Inspectionb - --- -------- - ---- -- ---------- ----- . SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9' 1-'68 Rev. 5M