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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No. - (Com le a in Triplicate) M Date Issued This Permit Expires l Year Date Issued -- ------- q $ i Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This applitation is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: t JOB ADDRESS/LOCATION ----'14 9-0--- `-------- ---- L - � '----------- --------CENSUS TRACT s -------------Phone ��- �-� Owner's Name - ---------- - , ��, ai = Address ="-' t yQ .0-------S; ". City ,v�- �`r O Ws . {' t it ! . -------- Phone Contractor's Name ---=----ly�'iZ'-s--- --- -------- ------------ - --=4---'---- =-------=-.license # -----;---:-- t ; � i i ti4 - Installation will serve: Residence❑ Apartment House❑ Comme'rcialr❑Trailertwe ®� t Motel Other ----------- ------------------------------ Number't of living units:. .___-- Number of bedrooms _ _ )t-Garbage Grinder _N-0Lot Size .......... A ' ---- Private ElWater Supply- Public5ystem and name _____________ ---- ------ - Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat ❑ Sandy-Loam Clay Loam.❑ r _ A` Hardpan ❑ Adobe_[, j FilMaterial .i-�►Q--- If Yes, type ---------------------------- I 4 (Plot plan, showing `size of lot, location..-of–system in relation to wells, buildings, etc. must be placed on reverse side.) NEW IN i P permitted e_•,---------------------------------------------if public sewer is available within 200 feet,) ` INSTALLATION: {No septic tank or seepage it ermined PACKAGE TREATMENT SEPTIC TANK fx Liquid Depth _ .-.` •.-•-.-.- ---eP C-- t �' Q�_-`'- T e .RE�9 g Material____-._.Aj...-- No. Compartments ----2-.__-.-.--- CS s i Capacity 4 J Yp S , --:'A`Tt�; # i Distance to nearest;4 Well ------------------------------------Foundati- ---------h-------- Prop. Line ----•-•--- -_...... LEACHING LINE [ No. of Lines "-.- r___"_--_ Length of each line--_.�5-------------- Total Length ---� .----- -•-- G `D' BoxFj .- .. Type Filter Mafierial _ > _---Depth Filter Material ------le?-------------------------- --- / ,tr Distance to nrest: 1N,ell --_--5�a___-__rcfoundation /0-----�------ ---- rProp".Lin eae; l { De th - Diameter - = Number ------------------- Rock .Filled -Ye's_ '❑f No I❑ SEEPAG.EPI [, 1.. P t } I �" 3 a vv, /Water Table Depth a ---------------------- -- --- Rock Size --- �� Distance.to nearest: Well ---------------------:74�'-------.Foundation ---------- -'------- Prop. Line _.-------------------- REPAIR/ADDITION(Prev. Sanitation Permit# -----------------------------I -'-: -�---- Date ----------------••-- � ` ) Septic Tank:(Specify Requirements) -------- -------------------------------------------------------------------------------- ------------'----,.------------------- ------.. i. -sDis oiy a I"Field {Specify Requirements ____�--_______ ------ -------•---- -- ----------- -------------------------------- It- -------------------- i '° -------------- ---- ---------------------------------------- . ----------------- -------- ----------� ta€ ----------- -- € (Draw existing and required addition on reverse side) t I hereby certify that Irhave prepared this application and that the work will be done in accordancer with San Joaquin County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health D!strict. Home owner d-r licen- sed agents signature certifies the following: f "I certify that in the performance of the work for which this permit-is issued, I shall not employ any person in such manner i as to be` a sub' o Wor s Co ensation laws of California." 1 1 ` OwnerSign e - ------------ -- -- ------- - -------------------------------- / 1 i Title (If other than owner) t FOR DEPARTMENT USE ONLY , APPLICATION ACCEPTED BY ----_F:Fi�Q - -------- ---- .. --------I DATE ---- � j0_ --------- BUILDING PERMIT-]SSUED _::_ DATE ADDETIONAL COMNINTS ^ — _ r - - _ ---------- --- -- --- -- ------- t ----"------ �------ — -- -=: - --- ------- ------ - --- - - --------- ----- _ i Final Inspe Date - "-- - SAN JOAQUIN LOCAL HEALTH DISTRICT ,l E. H. 9 1-'68 Rev. 5M,