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FOR OFFICE USE: 1 APPLICATION FOR SANITATION PERMIT - +7 - ---- -- - - Permit No. --- (Complete in Triplicate) pate Issued ______________' _. i ----------------------------------.------------------------ 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 fwith County jOrdinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION SS/LOCATION .---�fTO-- ----�------( -— ---------!_ ®-----------------------------CENSUS TRACT ----�`:_�/..... Owner's Name d/L :ir� �- T - --- ------- MALAS------��-58--)_Phone ff- .2 � `� ------ Address -----J4-13---- �C U City .-- ------------------------- -------------- ! Contractor's Name .-A� 3--___-, __ ' ,/ r-------------------------- License # Phone Installation will serve:'— Residence g Apartment House,E] Commercial ❑Trailer Court '❑ Motel ❑Other -------------------------------------------- Number of living units---- ------- Number of bedrooms ---/------Garbage Grinder Lot Size i _______________ Water Supply: Public System and name --------------------------------------------------------------------------------------------------------------Private Character of soil to a depth of 3 feet: Sand Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam:❑ I 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.) r NEW INSTALLATION: fNo septic tank or seepage pit permitted if public sewer is available within 200 feet,) 41 PACKAGE TREATMENT SEPTIC TANKX Size-- ! f ` rs ) 1, .. �--.��-� ---- --------- Liquid Depth --oaf----------------.----- oar .�MaterialF�`�tion __��'____________ pro Line ��___:_..-..__ � 1 Capacity 42474- Type R _ [�No. Compartments Distance to nearest: Well ___�!`V-__-- __ _ ! p. r LEACHING LINE No. of Lines ____J________________ Length of each line-----_-f$ --_--._-__-- Total Length ---SV...--............. 'D' Box ------------ Type Filter Material --------------------Depth Filter Material ---------.----------.----------------------- Distance to nearest: Well ______________________ Foundation ------------------------ Property Line -----______-______-_-___ SEEPAGE PIT [ ] Depth Diameter _______________ Number ------------------- Rock Filled Yes '❑ No Water Tabie Depth ------------------------------------------------Rock Size -------------------------------- Distance to nearest: Well ----------------------------------------Foundation -------------------- Prop. Line ---------------------- REPAIR/ADDITION(Prev. Sanitation Permit# __________ --------------------------------- Date ______--_________________________-1 O , Septic Tank (Specify Requirements) ------------------------------------------------------------------------------------------------------ - Disposal Field (specify Requirements) _________ c---lr�-------t -----!_-________ --------------------------- - ------- ----------------- ------ ----- ------------- Rf3C'�f - 1? -- � /11r - -------------------- -------------- ------------------------------------------------r------909L #43--------- e-E-v-� ---_------ _---_--- (Draw existingand 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 Ordinancesr State Laws, and Rules and Regulations of the San Joaquin local Health District. Home owner or licen- sed agents signature certifies the following: "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 Workman's Compensation laws of California." Signed ---------------- Owner B - --= --�--- - -,l!'� - - ---- - - -------------- -Title --- y ------ -E (If Zr than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ------- __-_-A 0------------ ---------. DATE --------------------------------------------------- --- ------- --- ------- BUILDINGPERMIT ISSUED ------------------------------------------------------------------------- --------------------------------DATE ------------------------------------------- ADDITIONAL COMMENTS ---- - ---------------------------------------------------------------------------------------------------------------------------------------------- ----------------------------------- --- - ------ ------------------------ - -------- - - ------------------------------------------- ----------------------------------------------------------- ----------------------------------- ---------- -------------------------- - - ------------------------- ---------------------------------------------------------------------- ------------------------------------------------- -- ---- ------- ----- - ---- -- - - Final Inspects --- ------- - - -Date ---- ------ -- --- ----- -r. SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M L