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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT - ... 1.:.3. -- F` ...7.�l�. (Complete in Triplicate) Permit No. ---_-. - ...... This Permit Expires I Year From Date Issued Date Issued ..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 Couritt Ordinance No. 549 and existing Rules and Regulations: jJOB ADDRESS/LOCATION ,-,.o........................_......_CENSUS TRACT ...:.....:................ Owner's Name .......... ---•• - ------------------•----- �_Phone .........----...............-_.-•_.Address .. Ci ..._.7-4 ..... ... +v .................................. Contractor's Name ._.. .. • .License # Phone , ' : ?. Installation will serve: Residence&Apartment House❑ Commercial ❑Trailer Court 0 Motel ❑Other ...................................... .... F Number of living units:--,__.. Number of b drooms _%Z....Garbage G •nder" _.. Lot Size ._. it`-.-�. C7. ....... Water Supply: Public System and name ---• - c-- -: 11" __..............•--•---•----'----------------...__--..Private ❑ Character of soil to a depth of 3 feet: Sand ❑ Silt❑ Clay ❑ Pent❑ Sandy Loam 0 Clay Loam ❑ Hardpan ❑ Adobey 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: Ic��FTZK'1[ s gn a pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT (No;VT(, et T{ } Size. Liquid Depth .. Capacity ----------------- Type .................... Material---------------------- No. Compartments ------•--- ....... T .. Foundation .............. Prop. Line .......... � r�,,�Distance t� S : - 11 -------............-•---- --••---_. •------- - . •J LEACHING LINE [ ] 'o ALi es ------------------------ Length of each line-------------------......... Total Length ....__...--•----•-----:. 'D' Box ..-------- Type Filter Material ...............•----Depth Filter Material 6 Distance to nearest: Well _----_-------------- Foundation _....................... Property Line ........................ m SEEPAGE PIT Depth It2_4.7 �___ Diameter Number ... ................... Rock Filled Yes or No ❑ . Water Table Depth 9V____________________•--._.--• r ....... � ..Rock Size -•-- --•�-..--------•---- Distance to nearest: Well ... __ ,, , ......Foundation _., ..... Prop. Line -------J f._... REPAIR/ADDITION(Prev. Sanitation Permit# .••_........................................ Date ..................................) Septic Tank (Specify Requirements) --••-•--------•............,�..,,./•. � - :.. _.................. v. Disposal Fieldecify Requir ents) .1r ��, ' ------- •--•• ---- --- ;0 .............• -------------------------------------------- -----.-------------..__..__......-----------•-------------------•----••----..._....._..--_-..-----------------------•-•--•--•---*....... (Draw existing and required addition on reverse side) 1 hereby certify that I have prepared this application and that the work will be clone in accordance with Son 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 as to become subject to Workman's Compensation laws of California." Signed ------- -------------------- ..................... Owner ......._ E (��iher�t�anowner] FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED 8Y ........ ......... ....44- ....................... DATE .. .s..... ...._ .. BUILDINGPERMIT ISSUED ----------- ---------------------------------------- - ..................................a..............DATE ........................................... ADDITIONALCOMMENTS -----------------------------------•---------•---•--• -- ...................:...................................................:.- ---- - .......--.. --- ......................... •.............. -•-••-• • -•--....... ... -. .... •. Final Inspection by: ..Date _.. SAN JOAQUIN LO L HEAlTH4 DISTRICT t� i 1 H. -'68 Rev. 5M 13 24 �Y _7/72 3 M p E. - -_ —