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i• • / .. e ///// _ .. ��i� . FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT (Complete in Triplicate) Permit --------------- --------------------- [ This Permit Expires 1 Y�r From Date Issued Date Issued _/l_10 f 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: l JOB ADDRE1S/10 rC7A,T�jON /.` S{/_ _ r ' --------------- ----------------- RACT ---5- �7------------ CENSUS T , Owner's NamePhone -------------------- Address l -S! ---- ---- - Cit c Y "�~- Contractor's Name _. Je _ - - _-_License # /yd'_Ma' Phone --------__________------_-_._ Installation will serve: Residen ❑Apartment House-❑ Commercial ❑Trailer Court Motel ❑ Other ---- Number - `Number of living units:_._______-- Number of bedrooms ---T.-----Garbage Grinder ------------ Lot Size .-A_f --------------- ,Water Supply: Public System and name -."-_-_______----. -------------- _..__.____Private [ '� -------------------------------------- Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Gay [v" Peat❑ Sandy Loam ❑ Clay Loam ;❑ Hardpan ❑ Adobe ❑ Fill Material ---.------__ If yes, type -"-- ----------------- (Plot _---___. -__ (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 seepage pit permitted if public sewer is avdilabl•'e within 200 feet,) PACKAGE TREATMENT [ SEPTIC TANKSize-9�9_Ir. 1,-IV__✓�_�.-._._ ._ Liquid Depth ._�_-�_..__-_---.----- - -.21 r i Capacity -tJ--- -- _ Type - ------------------ Material----�'-�ufi�--- No. Compartments -------- X, - r VI Distance -to nearest: Well ---------SP-F------------------Foundation "..--f-Q------------ Prop. Line --- --P- LEACHING LINE [t� No. of.Lines --- W --!_------------- Length of each line.---------J..�--a_ __--- Total Length .----f-b-�---•--_-------- 'D' Box __'iType Filter Material ___-, __"_-"_Depth Filter Material ---J `---__ Distance to nearest: Well --------- � L- _-_-- Property Line -._5_ - -------- Foundation ---- ---�- - - - --------•--•-- - S ' 3 ,, , SEEPAGE PIT [ Depth ____ ---- Number --- ..--_.�-.-------___ Rock Filled Yes I� No 0 `-Water Table Depth ----------Y-Q--------------------------------Rock Size _114P X__3__f-------- V � Distance to nearest: Well -----------1____1a_____________________Foundation ---I-V--_----... -- Prop. Line _.A---............... I REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date ------------------------------ 0 ,A Septic Tank (Specify Requirements) ---------------------------------------------------------------------------------------------------------- Disposal Field (Specify Requirements) -----:--_--_ ' F ------------------------ ------------------------------------------------------------------------------------------------------- ----------------------------------- ------------------------------------ -------- -------- ---------- --------------------- - --------------------------------------------------------------------------------------------------------- ------------------------------------- ' (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 Rules and Regulations of the San Joaquin Local Health District. Home owner or licen- sed agents signature certifies the following: a "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." f I Signed-------------------------------- Owner --------------- --- -- ---- -------------------- -- c -e _ -------------- Ilf other than owner] FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY -------------- ----- ---------------- DATE,---//-/-;7 BUILDING PERMIT ISSUED --------- -------- __DATE ------------ ADDITIONAL COMMENTS ------------ --- -------------- - . ------- -- ------- --- --- -- ------------- - __------------------------_-------------------__-------------------- _------------------------------------------------------------------ -------------------------- __. - Ae /h__ . _______-_____.__.�S____----_.___"-----___-_--.___-.-_-______-____-----_______-----------_-__-____-. _ ___I Final Inspection b = --------- ---------------- -------------------------.Date _.ff�1_'.-------«___.__ ---- SAN JOAQUIN LOCAL HEALTH DISTRICT ' E. H. 9 1-'68 Rev. 5M