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FOR OFFICE USE:. APPLICATION F6R SANITATION PERMIT ------------------------I---- ------ {Complete in Triplicate} Permit No, 4 ------------------ ----------- •-------:� ---------- This Permit Expires 1 Year From Date Issued Date Issued --/--- o=-?'b-- _ _ - ------ -- --- _ ---------------- --___-_--_-_------_ 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 .-•5�.�-/-_ tisrtL x Ll+ CENSUS TRACT _Sr d. Owner's Name ._.. •--------- --- ------Phone - - ------------------------------- Address ..... .--/ 5 --- --------------------------- City" St Contractors Nam`e''_ ' 3irw-�ts,-----------License # ------------------------- Phone __.----------------------_- Installation willeserve: Residence❑ Apartment Housef❑ Commercial []Trailer Court ;❑ Motel'❑ Other _a42/1r_111a1V/-------------- Number of living units:________.__ Number of bedrooms,-_______Garbage Grinder --------- -- Lot Size ----- 49 Water Supply: Public System and name ZL& /ae----------------------------------- -------------------------Private ❑ Character of soil #o a depth of 3 feet: Sand' Silt❑ Clay ❑ Peat❑ Sandy Loam •❑ Clay Loam ❑ ' Hardpan ❑ Adobe El 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 septic tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK �7 J ----------------- ------- Liquid Depth -----_4'/x -----.----- Capacity -f�Ca�--_----- Typ4r tee` ------ Material_Cv-?'ceelc—No. Compartments -- Z-.-----:---- r ! - Distance to nearest: Well ___...v -------------------Foundation -3 c:>.01 -Prop. Line --- --------_-- LEACHING LINE [� No. of Lines __-- - _.._______ - Length of each line;___ 6�?'----__-.____ Total Length ..___�- ------------- 'D' Box �----IType Filter Material Depth Filter Material ------/�F ------------------------ _____ + 16 Distance to nearest : Well _szs!t1.n,�-----------Foundation _�T-a-_`_._________ Property Line .___ ______________ t SEEPAGE PIT [ j Depth --------------- lDiameter _______________ Number _;___________ _____________ Rock Filled Yes (] No I] Water Table Depth -'--------------------------------------=------- Rock Size ,[ } _ Distance to nearest: Well ------------_ - _________________- _______Foundation -------------------- Prop. Line ---------------------- r�f J t REPAIR/ADDITIO1 (Prev. Sanitation Permit# ---------------------- -------------------- Date ----------------------------------) Setic Tank [Specify Requirements) -------- ------- ---- P I----------------------------------------------- -------------------------. Disposal Field (Specify Requirements) ----- _ ------------------------------------------- - ------------------------------------------------------------------------- (1. 1 --- ------ } ---------------- ----------- ------------------------------------------------------------- ------------------------- --------------------- 1 # % (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-Son 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 its issued, I shall not employ any person in such manner as to become subject to Workman' Com ensatlon laws of California." Signedl- ----------------------------------- Owner . BY ------=--------- -------- ----------------- ------------------------------------------- Title --- ------------------------------------------ ---------------------- (If other than owner) ( r FOR DEPA]ITMENT USE ONLY 4 APPLICATION ACCEPTED BY ----- -6.)1141------------------------------------- '------------------------. DATE -----1--9-e_-arte---------------- BUILDINGPERMIT ISSUED ---=-------------------- - -------------------------------- ------ ---------- ------------=--------------DATE - ----------------------------------------- ADDITIONALCOMMENTS ----------- -- -------------------------------- --------------------------- ----------------------------------------------------------------------------- -------------------------------------------- ----------------------------=------------ --------_--------, --------------------------------------------------------------------------------------- .--------- I • ` 5 ---------------------------------------------- ------------- - � - ----- --------------- Final Inspection b --------- -----------------------------------------------Date -- -----J0---7z2-------- SAN JOAQUIN LOCAL HEALTH DISTRICT t E. H. 9 1-'68 Rev. 5M