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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ---------"'------- ------------------- Permit No. .--------------------- ---------------------------- 3�_�__b S ------------- (Cpmplete in Triplicate) ------ ---------------- ' `--- ------------- - -3-73 This Permit Expires 1 Year From Date issued 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 withCountyOrrddiin�ance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATIO _,Z0.1.1-S2------�--------A]-l-l{tJ---- --1----- /'t ------CENSUS TRACT _ -'- �--------- Owner's Name ----- - _EBR ----- ----------------- ---------------------- -Phone --------------------------- ----- -- Address 20-1-1 l Q ------WA -----City ----- -�1�# c ------ Contractor's Name ---10 / �----------------------------- License # Phone Installation will serve: - Residence ❑Apartment House❑ Commercial ❑Trailer66mrt iEt Motel ❑ Other -------------------------------------------- G Number of living'units:- F �1. ----- Number of bedrooms - .....--Garbage Grinder� SLot Size - R —=--------- Water Supply: Public System and name -- ------- •-- ------- ---------- -- ----------------- ----- --------------Private Character of soil to a depth of 3 feet: Sand❑ , Silt❑ Clay FanPeat Sdy Loam e Cldy 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 INSTALLATION: (No septic tank or seep a pit permitted if public sewgr is ava`able within 200 feet,) Ir 0 PACKAGE TREATMENT { ] SEPTIC TANK'[© -10i�- -X T57---------- Liquid Depth ------------- � ` aterial-- N-�T No. Com ortments _--2—_......... �. Capacity��. ®.---- Type P f istance to nearest: Well ------------------Foundation ____ _.__" ""__ Prop. Line -__- .... -L__ LEACHING LINE No. of Lines ____0___ .—''3--__ Length of each Total Length -----/�Q------------ 'D' Box�E_S Type Filter M��atte�erial p-0CK._.Depth Filter Material _._.___.��__-_`._-__-____T.-- .-.---- Distancee to nearest: Well ---?cd.-f.=►►:----_ Foundation __A9-_""�- -:tiP erty Line _..�-_-- SEEPAGE PIT [ ] Depth -------------------- Diameter ________________ Number ---------------------------_NZock Filled Yes ❑ No i❑ WaterTable Depth ------------------------------------------------Rock Size -------------------------------- Distance to nearest: Well ________________________________________Foundation -------------------- Prop. Line ...................... REPAIR/ADDITION(Prev. Sanitation"Permit# .....---------------------------------------- Date ---------------------------------.) Septic Tank (Specify Requirements) -- -------------------------------------------------------- •- --- ---------------------------- ------------ +�—� Disposal Field (Specify Requirements) __--_--___ .I. L------- -- L �M�------------------------------------------------------------------------------_- -`--- ---- - _ - a ---------------------- ---------------- - ------------------------------------------------------------------------------------------------------------------------------------ (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 San Joaquin Local Health District. Home owner or licen- sed agen signature certifies the following: "I certif t at in the pe toce the work for which this permit:is issued, I shall not employ any person in such manner as to b o esubject to ompen afwn laws of California." Signed -- ---- ---- --------- - ---------------- Owner BY -------------- --------------------------------- ----------------------`TR-a_ Title -------------------------------------------------------- --------------- (If other than owner) y— FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY / s --------------------------- ------------------------------------------------ DATE ----- BUILDING PERMIT ISSUED --------------------------------------------------------------- ---DATE ------------- ----------------------------- ADDITIONAL COMMENTS ----- /_ � ------------------------------------ ----- ------------------------------------------------ ---- --- - -- -- -------------- -- -- ----- - - --- Final Inspection ----- -Date f '. _._-� SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M