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u FOR OFFICE USE: �O� FOR SANITATION PERMIT APt�LICATiON �, � ............."...- --.................... . ........... �i (Complete in Triplicate) -�•y^ ....--•.................... ...................:. P o- a 7 :- This Permit Expires t Year From Date Issued Dote Issued .1.....�..:.... 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 compliarled with County-Ordinonce No.,.549 and existing Rules and Regulations: JOB ADDRESS/LOCATIO .. i ..1: .. �f �/ .:'.................... :CENSUS TRACT ........_........:..._.... ................. --Phone ...-.-... -•--•-•. Owner's Nome ..L Fes. �X��/ �. •........................ ........ . .._....--..._ Address ..... f I %- -1_4441- 0 •��.�............. City 1� �........................................-- Contractor's Name ....,/ r f✓1� �"O�/� 10 ---•--•---------•--••••• ........License # -:.e Phone r• l Installation will serve: ResidenceP'Apartment House[] Commercial QTrailer Court 0 ;j Motel,[]Other ............................................ „ !�� Lot Size . 'If Number of living units..../A.... Number of,bedrooms ._ ......Garbage Grinder . .. . .-.. Water Supply! Public System;`and name -- ......... ..........-----•-•-•...............•------•-. ..........----•-=.........--••-•---------- •------'Private `-'V Character of soil to a depth of 3 feet: Sand.0 Silt[3 Clay -Q.—P.eat E]._ Sandy,Loam ❑ Clay Loam-0 I Hardpan E] Adobe Fill Material -.-....., . If yes,type ........................ -. .9 I � (Plot plan, showing size of164ot, location ofsystem 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,} II i PACKAGE TREATMENT { ] :E SEPTIC TANK.1 ] Size_..___.__-......-.....................---••--� --- Liquid Depth .................... • t 4 ' • ... No. Compartments' ...................... ';Capacity Type f Material. .....Foundation _ Prop. Line � t � Distance to nearest: Well ............................... -----•-------•------- •--....--•--......... LEACHING LINE No.,of Lines �;,Length of each line.--------------------.------ Total length i D' Box ------:=.. Type Filter Material �__ 'Depth Filter Mdterial Distance to nearest: Well ........................ Foundation .----_.------_..._:...__ Property Line ....... r-1-- ' SEEPAGE PIT [ } Depth -------------a ._ Diameter ................ Number -__------------ ----.. Rock Filled Yes d Na Water Table Depth`.......................... ...................Rock Size -------:....-:........... } I t 'X Distance to nearest: Well ...Foundation _-.------------------ Pfop. Line REPAIR/ADDITION(Prev. Sanitation Permit _::.- :.- ....... Date }...._ --•-•- 1 Mkt Septic Tank (Specify Requirements) ...................... :_ . ....-------.---•-----• .. -......-----• -- , -- ------------ - -- Disposal Field (Specify Requirements} ..��' _,�, _--_ -- � - `' --..,�zX........................................................................... I ------------------- -•-----------•---- ;-•-----.-...-----.-.......................................---.:------�--....------------:;'--..-.._._ .....-- •--- ........----------.--- (Draw existing and required addition on reverse side) ' 1 hereby certify that 1 have prepared this application and that/the work will beiione in accordance with San Joaquin County Ordinances, State Laws, and Rules and Regulations of then-San Joaquin Local (Health District. Home owner or licen- sed agents signature certifies the following: s � "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 .--.. _-.?fr II -----•--- Owner BY .-.... . Title ..... - ...: ........ ., `- .............: -------------•----•--.-..... Lo�w FOR DEPARTMENT USE ONLY 4 APPLICATION ACCEPTED BY . DATE .. p..3�.. .3........_•---•• PERMIT ISSUED ------------------------------------ BUILDING .......................••••••R�� ADDITIONAL COMME .'i ....._ •- .......................................................... - - .... r: _ _ ; _ _. f - .....................................................{ ....................... .._. .. -• ........... -- - V .........I....... ------------------............... -- _. ..... ............ ......... -------------------------- Final Inspection by ` ...............Da e ....,:SAN AOAQUIN LOCAL HEALTH DISTRICT r u 13 24 I.-AA Rev- 5M !I - j 7/72 3 X_