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, 1 r FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT - --- _ y- . ---------------------------- Permit No. (Complete in Triplicate) 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 applicatiarl,1 1e in compliance with C ty Ordinance No. 549 anexisting Rules and Regulations: JOB ADDRESS/LOCATION .-- j - pa'----- _1_f ----------- �f�! --CENSUS TRACT -------------------------- Owner's Name _ .it/ h_Ge nl.f 'O Phone _-. >�� ►� -- Address --------------------=-------- f � �--e_��G't/�- -----------._.. City ------- /� -------------- --4/Gvn --.License # ------------------------ Phone --------------------------- Contractor's Name -------------------•-- -- -- ---=------- '\ Installation will serve: Residence XApartment Hovse,❑ Commercial ❑Trailer Court ',❑ Motel ❑ Other -------- ----------------------------------- r Number of living units:__________ Number of bedrooms __,3--- Grinder ^r-___ Lot Size ---�_ -�,�.,.�----------------- Water Supply: Public System and name ----------------------------- --------------------------------------------------------------------------------Private — Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam '❑ �C� 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 seepa a pit ermitted if publi sewer is available within 200 feet,) PACKAGE TREATMENT { ] SEPTIC TANK �'r r'�� Size--------------_�' � ----- -- Liquid Depth ________-_____________--_- Capacity /0-W---- Type el'C�--�� Material_ Compartments __�________---- Distance to nearest: Well ____._ ---------- ______________Foundation _____ ______ Prop. Line __�1f r e........ LEACHING LINE [ No. of Lin s --------- -------- _______ Length of ea h line � _a 74--- Total Length - � I` 'D' Box _0- _ Type Filter Material 4__ epth Filter Materia! ______-_/4; ___._________________ Distance to near. st: Foundation 140 .-______ Property Line ___ SEEPAGE PIT Depth __"V--`____ Diameter ___ _ / _ ________ Number -------- - ____ Rock Filled Yes No 0 Water Table Depth -----------�!_� --_- - ------------Rock Size ------`—--- ----��------- Distance to nearest: Well --- --__--� �_r___-________Foundation -.14 _ _______ Prop. Line REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date ----------------------------------} SepticTank (Specify Requirements) -------- ------------------------------------------------------------------------------------------------------•---------------------------- DisposalField (Specify Requirements) ------------------------------------------------------------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- (Draw existing and required addition on reverse side) I 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 Mules and Regulations of the San Joaquin Local Health District. Home owner or licen- sed agents signature certifies the following: "I certify that in a performance of theyrork for which this permit is issued, I shall not employ any person in such manner as to becom /suect Wok an o pensation laws of California." Signed _X - -- Owner BY ------------- ---------------------------------------------------------------------------------------- Title ---------------------- ----- ------------------------------- (If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ------------ '--------------------------------------------------------------------=------- DATE ----- ------------- BUILDING PERMIT ISSUED -- - ------ -- �y� -- ---- - --- DATE ------------------------------------- ADD IO AL COMMENT �Q --� _DQE - tf r, ------ / ----- , y� /y`---"- - --- - ------- --- •-�Q'�t' '�' `_ -- -------- idl/ `rte' F 7y---- --------- s. - � s�T- ----------------------------------------------- ---------------------------------------------------------- ----------------------=------- PFinal Inspection by: c. -------------------------------------------------------------------------------------------Date SAN JOAQUIN LOCAL HEALTH DISTRICT CS E. H. 9 1-'68 Rev. 5M.