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FOR OFFi'CE USE' APPLICATION FAR 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 per 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 1 - -L ------- A_tQ�_A-------F� �SC - -CENSUS TRACT Owner's Name !�n -!_�. L- � U_ p� ---------- --------Phone O Address /rJ !1 ��- L1V7Q ------------------------------ ------ •-- f�`d Contractor's NameIVED----(1OIVN0_R5-- ------------------------- ---------- --------.License # ------------------------- Phone ---------------- Installation will serve: Residence �,partment House❑ Commercial:❑Trailer Court Motel,0 Other -------------------------------------------- F' Number of living units:---- /_ Number of bedrooms-_3------Garbage Grinder Lot Size �S�� - ------ -------- Water Supply: Public System and name ---- ---------------:------•------------------------------ ----------------------------------------------Private 2- - Character of soil to a depth of 3 feet: 'e Sand'❑ Silt❑ Clay ❑ Peat❑ Sandy Loam Clay Loam '❑ M Hardpan ❑ % Adobe.� Fill Material -- s�: 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 it permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT { ] SEPTIC TANK' Size___.1_. �C� X-_-5•'------------- Liquid Depth ��_""___"__------ Capacity _.___ Type p�rvWW Material CO O R�No. Compartments ----Z7.----:.. V� Distance to nearest: Well µ ` ____ ___ Prop. Line ____ ________�__ouio LEACHING LINE �No. of Lines ___ Length each-iinedotal Length ------/_5 Material --- ----------------� r 1n 'D' Box�_ ype Filter •Materia�_-__Cl' }oe�pth�Filter Mater � . / E.� T Property Line -5____'�` Distance to nearest- Well ____<S __________ ----- p ty SEEPAGE PIT [ Depth _../vl �.___ Diameter Number .__.__ ---= Rock/Filled Yes �o 0 A. Rock Size�Water Table Depth _-n ------ r 'f Distance to nearest: Well ------/�Z9--------------_-------Foundation .. -------4--_ Prop. Line ....5-_--------_.. REPAIR/ADDITION(Prev. Sanitation Permit# -----------------------"=-------------------- Date ----------------------------------I ;. Septic lank (Specify Requirements) --------------------------------------- ----------------- -------------------------------------------------- - -•----------------------- -•--- IR-- - - + Disposal Field (Specify Requirements) ---------------------------•--------------------------------------------------------------------------------------------------------- 5 - ------------------------------------------------------------------------------------------ ---- -------------------'----------- (Draw existing and requir rd addition on reverse side) 1 I hereby certify that I have prepared this application and t at the work will be done in accordance with San Joaquin County Ordinances, State Laws, and Rules and Regulationsfof the San Joaquin Local Health District. Home owner or licen- sed agent i nature certifies the following: f" "I certify t t in t perfor ante of the work fat which thi, permit is issued, .I shall not employ any person in such manner as to bet sub' ct to akman's Compensat}on laws ofCalifornia." + Signed f----------------- ------------- Owner BBy `R-- --- = -- ------------- -------------- - - -----------------=-'`---,---�---------- -'�- ---'-- Title - - ---- ��" (If other than owner) r1" _ - =~ � FOR DEPtARTMENT USE ONLY " APPLICATION ACCEPTED BY 4--'-- 0 --------- -�1--�:, DATE -- --- L.�.�/ ----------- BUILDING PERMIT ISSUED ----------------------------------------- }-;---------------------------- Ic ----------------DATE ------------------------------------------- 4 ADDITION 4L COMMENTS " - ---� ---� �------- r �----- -� -��--------- ----------- -------------------------- -�_ ------------------------------------ -. F= - ------- -- _�.. , Fj Inspection by. . �}i"s _ w".,, ----- -- :: -------Date --- -- - f . SAN JOAQUIN LOCAL HEALTH DISTRICT _',� r E. H. 9 1-'68 Rev. 5M t',