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FOR OFFICE USE: APPLICATION FOR SANITATION PERMP --------------------------------------------------------- (Complete in Triplicate) / 7' Permit No: ______________ 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 with County Ordinance No. 549 and existing Rules and Regulations: iqJOB ADDRESS/LOCATION .- ---- -- ----- -- -�Q--- --------•----------------------- ---CENSUS TRACT --- �-57J------- Owner's Name -----:-65fq�� A_K' SJ._n1V._D----_---•------- _ - ----------- -------Phone --"-7 --l-•C� rLl Address ! L-------- :z plEn I----------------------------------- City __^q N �C_a------------------------------------- Contractor's Name ---------Q -------- -. .—__ --.License # -------------- --------- Phone ----------------- a Installation will serve: Nf� Residence partment House❑ Commercial:❑Trailer Court ❑ x r G _Fmotel F-1 Other _ ------------=----------------- � 1. Number,of living units:_-_ _ ___ Number of bedrooms -3______Garbag�e Grinder� Lot Size - _J*-10.0(9-.17__-'47_-. Water Supply: Public System and name ---------------------- ----------•--- Private, , Charact�r of soil to a depth of 3 ft: Sand❑ Silt❑ Clay ❑ r Peat Sandy Loam � Clay Loam ❑ Hardpan ❑ Adobe-E] Material ___ If yes, type ___!-_-__-_______ _ 4 � (Plot plan, showing size of lot, location of. system in relation to wells, buildings, etc. must be,�placed on reverse side] "I" �>- NEW INSTALLATION: (No septic tank r seepage pit permitted if public sewer is avail ble., Ithin 200 feet,! PACKAGE TREATMENT [ ] SEPTIC TANK [ ] Size_____ _ ---------------------- :,` ------- Liquid Depth ---------rr�_---_,___________ Capacity ---------- ------- Type -------------------- Material------------------ No. Compartments -----------------=--- I Distance to nea est: Well --------------------------- '.;Fb.undation--- ------------ Prop. Line ---------------------- LEACHING ------------------ --LEACHING LINE [ I No, of Lines __-._ � ___1Length of eachkline_____________________ _ ____ Total-Length ------------ ----------------t r D' Box -------- ype Filter Material ________________Depth Filter aterial { Distance to eq a t; Wel) -____ Foundation I------- Property Line R r dation ---------------•-•-•--- SEEPAGE PIT De #h ------------ - i � - [ ] p Diameter ------ Number ------------------ - ------- Rock:.�Filled Yes ❑ No c Water Table Dep ------------------------------------------------Rock Size ----- -----------------.----- ?r. Distance to near : Well -------- -- -------------------- --------Foundation . Prop. Line ---------------------- REPAIR/ADDITION(Prev. Sanitation PeFm_ i ..___.____------------------ ------ Date._____________ i_--__--__--____.a t; R SepticTank' (Specify Requirements) ------- --------------------------------------------------------- --------------------------------------------------------- e ----------- -_--------- ------------------------••-- 1 Disposal Field (Spmeecif y fRee[quirements). ._ L,r ::= = p ______�,�_--------- ---------------------- ______-- _ ------ ------ '^"?r 4r�; � _ _ •' --------------------- t3 F r 1 .�+. �� ------ ---------- ----------------------- ----------- - -- -- F �--- ` r --------- --------------- ----------------- -- - -------- ---- -- - -- v (Draw existing and required addition on reverse side)j I hereby certify-that.-Ixhave-prepared-this•-application-and.-that the. work.will be done in accordance with San Joaquin County Or antes, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner or licen- sed agent gnature certifies the following: "I certify t in the pert r nc of tate work for which this permit is issued, I shall notzemploy any person in such manner as to beco s4 3 ublect to km s Compen ation laws of California." t I4 Signed l -- -- - `-------------------------------- Owner } b BY ---------------'-------------------------------- ! __ �__. Title ---- -------------------------------------------------------- ----- (If other than o ner) FOR DEPARTMENT USE ONLY I APPLICATION ACCEPTED BYE --------------------------------- ------------ ------------------------ DATE --- - - " BUILDING_PRMIT ISSUER_,___,_ _-_ _-- _ --- -� .-- DATE. --- , ADDITIONAL COMMENTS --�----------- ------------------------------------------- - --------------- --- t- y- -------- ------- - ----------------------------------------------- ------------------- -------- 7 _ Final Inspectio . ----- - - - - - - ----- -- ----- ---= ----------------- ---- Date SAN JOAQUIN LOCAL HEALTH DISTRICT I E. H. 9 1-'68 Rev. 5M. I