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FOR OFFICE ITSE: APPLICATION FOR SANIT'A#ION PERMIT Permit No. &q _9 This Permit Expires 1 Year From Date Issued /_' : �,6 {Complete in Triplicate] Date Issued 0 -----------------------------,--------_ _ ---- ------- 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/LOCATION .-_� 2w---- ;---(`-W�~ ---- -----------111.77'.-0------CENSUS TRACT --J----��----- Owner's Name �= /� f t-? ----- -------------------Phone ------------------------------------ --------------- Address3 (" --- -' GG ------------------------------------- CityPFJ------- 40----------------------- Contractor's Name -- ------ ------------------License 4D`Y9.__47----- Phone Installation will serve: Residence �partment House❑ Commercial :❑Trailer Court °❑ Motel ❑Other -------------- ---------------------------- Number of living units:-- -- Number of bedrooms -_27-----Garbage Grinder _/V0--- Lot Size ----�- Water Supply: Public System and name ------------- - ---------------------------------------------- --------------------------------------- --------Private Character of soil to a depth of 3 feet: Sand'g-- Silt❑ Clay ❑ Peat❑ 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 IN TALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAG TREATMENT [ I SEPTIC TANK!Yr' Size--.�lq X�_-y.K.------_-------- Liquid Depth -_-----�-tT-••^----__ Capacity !a-©0----- TYPgph-�-��A5` J --- Materialr0w('e? �-__ No. Compartments _-- Z__-_-_-_--_ Distance to nearest: Weil --_S71)--_---_--_-_----;------Foundation ---5-_a----------- Prop. line ------------------- -- g„ LEACHING LINE Y-)-' No. of Lines ... -.---_------ Length of'each line--- 1---- Total Length -__1�_ ________ ____ 6� r 'D' Box -1-------- Type Filter Materialk_©S_l-------_Depth Filter Material -------/-7' _______ Distance to nearest: Well ----_5^0------------ Foundation --- _----------- Property tine � ------ ---------- SEEPAGE PIT [ ] pth ------------------- Diameter ---------------- Number --------------------- ------ Rock filW Yes ❑ 'No War Table Depth ------------------------------------------------Rock Size -------------------------------- Distan to nearest: Well ----------------------------------------Foundation -------------------- Prop. Line ------------------ REPAIR/ADDITION{Prev. Sanita ' Permit# -------------------------------------------- Date ----------------------------------11 SepticTank (Specify Requiremen ------------------------------------------------------------------------------------------------------- Disposal Field {S cify Requirem�ntsl!7u ----- �3---- - - - ----- --- --------" ---------------------- -------------------- '------------------ o -------------------- , /.--------- ------------------------------------------------------------------------------------------------------------------- --------------------------------------------- --------- -------------------------------------------------------------- --------------------------------- ----------------------- --------------- (Draw existing and required addition on reverse side I hereby certify that I have prepared this application and that the work will be dere 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 c rtifies the following: "I certif in th p rform a of the work for which this permit is issued, I shall not employ any person in such manner as to co a ubi c to W an`s Compensation laws of California." Signed -- ---- -- ------ Owner By ------------- ----------- ----- t{� =--- Title -------------- -- - ------------ --------------------------------------- (If other than owner) ll FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY --------/_/__` �/_ DATE t- BUILDING PERMIT ISSUED ----------------- -- ---_ DATE ------------------_--_----------_ ADDITIONALCOMMENTS --- --- ------------------------------------ - ----------------------------------------------------------- ------- --------- ---------------- ------------------------------------- --------- - -----------------P ------- -- -- -- ------------------------------------------------------------------------------------------------------- ----- ---- ------------------ ---- Final Insp • n by: - -------------------------------------- Da SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev, 5M