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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT + �.�mplete in Triplicate) Permit No. ------- I--------------- ,:. . 3 ----------------------------------------_____ ___________ This Permit Expires 1 Year From Date Issued Date Issued ,,Application is hereby made to thfi-San Joaquin.Local Health District for a permit to construct and install the work herein. r� described.:'This a pplic�ion..isimbde in compliance with--County-Ordinance Nb. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION J�3 J ------i��-----------1�--�C`---.CENSUS TRACT �J ----------- �r Owner's Name -- ----- D_ Ek-G-19--------- -------------------'---------------=- --------------Phone --------------------------• .----- Address ------ -------------- --------- - City --=----------- ....... y Contractor's Name -------- � . µ ' see : s r (- Ci i 1� License # Phone ---------------------•-------- 1 �t. Installation will serve: Residence Apartment House❑ Commercial:❑Trailer Court ❑ P Motel ❑Other -------------------------------------------- Number of living units:.--- ------ Number of bedrooms --------Garbage Grinder _ Q..__ Lot Size _A_R�fA_64 ............ Water Supply: Public System and:name ---------- - ------------------•--------------------------------------------------------•--------------------Private Character of soil to a depth of 3 feet;- Sand'Q Silt El Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam P - 'I(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 septi Of c,tank or seep pit permitted if ublic sewer is available within 200 feet) f� ' PACKAGE TREATMENT { ] SEPTLC TANK Size_ __ Liquid Depth _-- - ------- Capacity 4. D ___; Type b9EFOB Material_4�',0 NCR.J-- No. Compartments Z�. r P /Distance -to nearest: jWell _ ------t----------------- ion -149--- Prop. Line __ ___-__._____ : Foundation ` LEACHING LINE No. of Lines --- ----------------- Length of each line----- \-:___-------- Total Length ----fAVQ______1.________ 'D' Box _ Type Filter Material !}a_ �f `� YP ---Depth Filter°,tMaterial --- ---- -•---------------- . Distance toynearest: Well Jr ____"<`_____ Foundation ___/[!_____11"11`:----- Property Line }� s: SEEPAGE PIT Depth 'f / ------- Diameter Y X__�___ Number __ '0'-7 Filled Yes No i❑ `� Water Table Depth ---ir -------------------------------------- / �i�S / •I r{ Rock Size -- -�-----�-�--- ...,�_ Distance to nearest: Well _- �© __ _____________Foundation __/ ___ Prop. line _ __..____. ---------- - _- ,_� REPAIR/ADDITION(Prev. Sanitation Permit#'- '_"=____ _---:'--_-��______________ Date -`_ 'r________________________1 Septic Tank (Specify Requirements)! ----- == - r------------ -----------------------------------—--------------------------- Disposal Field (Specify Requirements) ---------------- ------------------ -------------------------------------------- } ' w ' -----••--------- R (prawexisting and required-addition on reverse Side)'"' I hereby certify that I have preparA_Wis`appliiation 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"c-rtifies the fol)owing: "I certify th in the performantcte f the work for which this permit is issued, I shall not employ any person in such manner + as to beco ` ubieci orkintr s Compensation laws of California." Signed ---- ---- --- --------------- Owner BY ------------------- ------------------------------ - ------ -------- 0- --------- Title ---------------- -- (If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY _A_R_------ ------------•_---- DATE ---- 3- �- ___-_--- BUILDING PERMIT ISSUED ---------- ��'[y. - --- --------------------------------------------DATE ------------------------16-7 COMMENTS __ _ V1_ 0;1�- . - -, _ _ -- ----- - -- ------------ ---------------------------- -- ---------- -------- --------- ------ -------------------------- ---------- ---------------- nZo `al llFin � SAN JOAQUIN LOCAL HEALTH DISTRICT I E. H. 9 1-'68 Rev. 5M iN `F