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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT - --------------------- -------- Permit No. _rte- 1-11 (Complete in Triplicate) ---------- � -.- Date Issued -7-:.__ 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: JOB ADDRESS/LOCATION .----��n�-----C�-vLll/_��'L_-r/�-�----------- - -�--�Cf}-----------CENSUS TRACT ------- ---------------- Owner's Name _--'1 �'I,c? C_/1 Phone --------------------------- --------------- Address ..... ----- .a' _ -1-�-- ------------- • City _iM?'�l l�(_.Lpl - - ---------- Contractor's Name ----- lam. t "C2 --------------------------=------ L' �j License # -2--KV13' Phone �l. -'---- Installation will serve: Residence ❑ Apartment House❑ Commercial ❑Trailer QXPi� Motel ❑ Other ---------- -------------------------------- Number of living units:___ Number of bedrooms ------Garbage Grinder v . %Lot Size . 1QQc- -----#`--------------- Water Supply: Public System and name ---------------- ------------------------- Privateer Character of soil to a depth of 3 feet: Sand'F Silt❑ Clay;[] Peat❑ Sandy Loam ❑ Clay1cam jI - obex Fill Material �_:77:If es,type - ------_ -Hardpan0 Ad (Piot 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 seeps pit permitted if public sewer is available within 200 feet,) , PACKAGE TREATMENT [ I SEPTIC TANKSize-.- xJV_ - Liquid Depth _. ---------------- ------- Type - :IZC C Capacity/ -- yp j�---------1Material_ �_ '. ____'-�No. Compartments _ ----- Prop. Line --- --------- f istance to nearest: Well --------67--------------------Foundation -.--_�-..------ LEACHING LINE No. of Lines ---.�------------- -- Length of each line-----/OD-------------- Total Lengt/ --fpQ---------------- ?ac p --------------------- 'D' Box -__. Type Filter Material �_________________De Depth Filter Material _./_��____-___-- � Foundation --- Property Line --- '------------- Distance to nearest: Well ___-_�___-- ---- SEEPAGE PIT [ ] Depth --- Diameter --- Number ---------------------------- Rock Filled Yes ❑ No 0 WaterTable Depth ----------------------------------------------- Rock Size ------------------------- ----- Distance to nearest: Well ----------------------------------------Foundation -------------- Prop. Line ----.----------------- RIEPAIR/ADDITION(Prev. Sanitation Permat# --------------=----- ----------- -=-- Date ----------------------------------) Septic Tank {Specify Requirements) ----- ----- --------- ------------- --.------------------•---------- Disposal Field (Specify Requirements) ---------------------------•------------ --------------------------- ------------------------------------------------------------------------------ ----- - -------------- - = ---- - - ------------------ (Draw --- - ------(Draw existing and 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 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 i as to become subject to W man's Compensation laws of California." ; Signed ------ ---- Owner /DEPARTMENT Title - ------------------------------ (If other than owner) F USE ONLY ------------- APPLICATION ACCEPTED BY -----Tt A. 1------------------ -- ---------. DATE --------------------------------------------- BUILDING PERMIT ISSUED ---------------------- - ------------------------------------- --------------DATE ------ ADDITIONALCOMMENTS _ ----------- -------------- -- --- ----------------------------- --------------------------------- . ----- -------------- -------------------------------------- --------------- -------------- - ------------------ -- -- ---- ---- ------ ----------------- - - - -- ------ - - ------ --- - - ---------------- ` Final Inspects ---Date ---- -- -------- - ------- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M