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FOR OFFICE USE:}_ APPLICATION FOR SANITATION PERMIT - ------------------------------------------------- Permit No. (Complete in Triplicate) -----------------------------------------______________- This Permit Expires 1 Year From Date Issued Date Issued 0*___ _- Q 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: � � �! r JOB ADDRESS/LOCATION .___.- _ --- p_ --------4 -----_-c„�_ / 7`O N-._-__L�--------CENSUS TRACT -----: ------- Owner's Name __— -------------`9-'4-1Z77 -----------------------------------------------Phone ----------------------------- Address, 7 __ ---------�-------- � . -Q- - Q---------- Ci �~cP c,�+ !L�`-------------- ----------- ----•--------- r _ _ city Contractor's Name 4 �Jy - 1�� iCs'�# Phone ----------------------- Installation -•- -J Installation will serve: Residence,21 Apartment Housef] Commercial ❑Trailer Court ,❑, ' Motel ❑Other -------------------------------------------- Number of living units:-----6___ Number of bedrooms ---- ---Garbage Grinder _________ Lot Size ------------------------------------ Water Supply: Public System and name ---------------------- ------------------------------------------------------------------_--------------------Private ,] Character of soil to a depth of 3 feet: Sand'® Silt❑ Clay.❑ Peat Sandy Loam •❑ Clay Loam-[:] �-,...._. ,Hard pan_❑,._Adobe-❑ ;;.Fill Material_---- -U---,Lf,yes,_tYpe--•-•--_•-.:------_-•v�_�.,.,�, � i (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 seep❑ pit permitted if public sewer is available within 200 feet,} PACKAGE TREATMENT [ I SEPTIC TANK![&.r Size____ OQ Q-A- V -------------------- ------------- Liquid Depth --- ---------------- Capacity 11-JI-0-43---- --- Type -r_4f&4fM;Material---------------------- No. Compartments -----------------:---- O istance to nearest: Well ------ ------------------- _.---- ----_-- ._ ______-_ Prop. Line _ _�__.-_. v LEACHING LINE �No. of Lines -------/_---_________ Length of each line_____ �-�_- _-_____ Total Length ___ _ �� 'D' Box _-A_1--- Type Filter Material �----------De'pA Filter Material ----/Op-1____________________________ Distance to nearest: Well ____ .:i ___________ Foundation ___ ________________ Property Line __-�f_______________ SEEPAGE PIT [ ) Depth ____ _ ------------ Diameter -------- ------- Number ---------------------------- Rack Filled Yes ❑ No .iQ WaterTabt le Depth ---------------------- ------------•----•-------Rock Size ------------------------------- _. Distance to nearest: Well ----------------------------------------Foundation -------------------- Prop. Line ...................... REPAIR/ADDITION(Prev. Sanitation Permit# ----------------------------------------- Date ---------------------------------_) Septic Tank (Specify Requirements) ------------------------------------------------------------------------------------------------------------- I Disposal Field ]Specify Requirements) fo'} ...________Be_Q)_>1o0M------- l�:D��_ --------------------------------------------------------- ----------------------------------------------------- ------------------------------------------------ ------------------------------ ------------------ -------------------------------------------------------------------------- ----------- ------------ _ (Draw existing and required addition on reverse side) I hereby certify that 1 have'prepared—this' applit6tion 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: "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 beco subject to W6 . man's Compen ❑tion laws of Califor ia." Signed d=-;—dam s� �wner By -------- ---------- ------ - _ -l_� -- Title -------------------------------- ------ (If other an owner] FOR -DEPARTMENT USE ONLY APPLICATION ACCEPTED BY -- u - ---------------------- ---------------------------- QATE -- = BUILDING PERMIT ISSUED -- -----------------------------------------------------------------------'f-------------------DATE ---------------------- ADDITIONAL COMMENTS f `------- . - - ---------- - --------------------------------- ------------------------- -----f ------- --- - --------------------- -------------------------------------------------------------------------------------- ------- ---- - - ---- ---- Final Ins pectio = ------------------------------------------.Date ` / r SAN JOAQUIN LOCAL HEALTHFDISTRICT E. H. 9 1-'68 Rev. 5M I&