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FOR OFFICE USE: .�, APPLICATION FOR SANITATION PERMIT �� -------------------- ------- -------------------------- � p -' - 1 (Complete in Triplicate) . ____9__' Permit No . -----------------------------------•--- ---- --------- Date Issued _________________________________________________________ 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 with County Ordinance No. 549 and existing Rules and Regulations: q JOB ADDRESS/LOCATION CENSUS TRACT ___________--.----------- Owner's Name __ - "' Lr +- _ ... -------- a e ------------------------- .......... Address _ ___l�-ter �✓IJ - - -- �'� City - Contractor's Name __ t'�_ _ � ._ __ _ _ ''10.149-C.---------License # >SG/1�. Phone -��-_3/� Installation will serve: Residence ❑Apartment House❑ Commercial Otrailer Court 0 Motel F-1 Other ------------------------------------------ Number of living units_____________ Number of k-drooms ------------Gar age Grinder ------------ Lot Size D__ _,?,e7e.......... �J�Water Supply: Public System and name --- �- \ -�Lr2+C. ------------------Private ❑' Character of soil to a depth of 3 feet: Sand❑ Silt❑ Gay ❑ 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 INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK Wize- _�.. __e:�+ q p �\ ' - Liquid Depth _.. p 0 Capacity/_ V_0 Type at nal_0 ---- No. Compartments -----C;Z -• v Distance to nearest: Well g i ......... _..Foundation --- ----_------prop. Line .S.. LEACHING LINE No. of Lines ____. Length of ea line. // / / ------�----- g -19-Q------�-l.1--- Total Length -,/-awQ_----•-------- D' Box ----/.___ Type Filter Materi I __J�_-!7dr f �� yp _ _ epth Filter Material ____ __�_______________________________ Distance to nearest: Well Foundation ---yam` ------------ Property Line ___.F!/- a _ SEEPAGE PIT K Depth p .�-_�______ Diameter �_�_.__ Number _______c�.___+._____ Rock Filled Yes No i❑ ,� Water Table Depth --------- Q-------- ----------------------Rock Size ---1,3----------- Distance to nearest: Well' =.....Foundation ----ftT--j.--- --- Prop. Line REPAIR/ADDITION(Prev. Sanitation Permit# ____________________________________________ Date ------.-__________--___-__._______) SepticTank (Specify Requirements) --------------------------------------------------------------------------------•------------------------------_-------------------------- Disposal Field (Specify Requirements) __________----------------------------------------------------------------------------------------------------------- --------------- - -------- ---------------------------------------- ---------------------------------------------------------- ------------------------------- (Draw existing and required addition on reverse side) -e - 1 hereby certify that 1 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 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 be e s b(�ect to Workn's Compensation laws of California." _.. Signed -------- e - " --------- ------ ---- Owner An Ir, BY ------------ -, Title ---------------------------------------------- ------------------------- (If othe t an owner) OR ARTMENT USE ONLY APPLICATION ACCEPTED BY -------- - DATE --------------- BUILDING PERMIT ISSUED ---- DATEk- ------------- ----------------------------- ADDIT AL COMME�NT - ------ ---- - ---- ------------------------------------- -- �- ----- = FinalInspection by: ------------ - -----------------------------------------------------------------Date -.- --------s}- AQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M