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FOR OFFICE USE: APPLICATIONOR 'SANITATION PERMIT Permit No.Triplicate) �...�...._.. ..................................................... .3....6•.. � ....................................................:. his Permit Expires 1 YeartFromDate Issued Date Issued 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-compliq�ce with County Ordinance No. 549 and existing Rules and Regulations: j JOB ADDRESS/LOCATION .``.== i_.. ...... .........................CEKV US TRACT ................ ... Owner's Narne� ._Q..11 Y1 -- - -- ... ............ ...............--.. =....... ~ .--- ..Phone c Address------.... r-� � � ............... ... •--• •---- Ci .......... ........................... ty Contractor's Name ,11 Qfi /:. 1_¢_t~..[ m- -_.,S_ .._.....License # �. .. .... . Phone ............. Installation will serve: Residence C]Apartment House 0 Commercial:❑Trailer Court 0 Motel ❑Other • r Number of living units:.,_. ------ Number of bedrooms ..._,...Garbage Grinder ............ Lot Size ..... 4)_. ...... Water Supply: Public Sys em and name .........................................=-----------------------•----------•-......................Private Character of soil to a'depth of•3 feet: Sdnd\o•, . Silt❑ Clay ❑ Peau[] Sandy Loam 0Clay Loam ❑ Hardpan Adobe ❑ Fill Material ............ If yes,type ................. Mot pian, showing size of lot, location ofsystem: in relation to wells, buildings, etc. must be placed on reverse side.} N6 INSTALLATION: {Noseptic tank or seepage pit permitted If public sewer is available within 200 feet.] , I Le / �r PACKAGE TREATMENT [ ) SEPTIC TANK[f�}`, Size.._.a�...�A.u7-_�/ �jQ...._- ___.. Liquid Depth ..)4................... A � r Capacity J _ . J. Type 0_. MaterialAb� ngf.� .E:No. Compartments :......:.... I _..�... Distdnce to nearest: Well ..... �......................Foundation .._:�(1......... Prop. Line .-.- -11_G_---` G w—s l LEACHING LINE [ N " pf Lines .......�Y;----___--- Length of each line.-. U.._._____. Total Length ..../...IJU......:._� kA o- : I f /� 0 D'='Box --•.- ----- Type Filter Material ----- ....Depth Filter Material --------4.9_1-11. ...................... Distance to nearest: Well ...... Foundation ._..- -------- Property Line ........ ' SEEPAGE PIT p(J Depth ___ _.__.._ Diameter .. ER �� ,.� ��._ Number ._.__..__.�_____________ Rack Filled Yes No ❑i . f r -r s r { Water Ie.Depth,..............•-�..I'�....----•:_...:........Rock Size ........ -------------- --•--- Distance to'neMa�rest: Well __._Zef Q. ....................Foundation .ICI:Gt.__ Prop. Line . r1..r�..._.. • REPAIR/ADDITION{Prev. Sanitation Permit# ..........._._._____________ ______________ Dote .............................. � , Ud .. Septic Tank (Specify Rego:rement's�---�-------.-.I_�--------_j��.�. ...........................................-----••----....`...._.....�--------.moi..._...--i Disposal Field {Specify Requirements} .......�Cj�-..... -.----- - ------ 0'S ------_-- ' `� i - �v --- ' - - •----------------••-...-•----......_.......... .----.-----•----------••----•---•--------••---• ---•-•. Q = - I A 1A ,i ..................... .....-,,;_--_-_.--_---_,_._---_-_-.------------.......�....,.........------•----•••--- ••---• •--•..... _ f (Draw existing and required addition on reverse side) , I hereby certify that I havep er pared 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 licew-- sed agents signature certifies the following: t "ll certify that in the performance of the work for which this permit is issued, 1 shall not employ any person in such manner as to become subject;tolWork—mwn's`C6-m�4 dsation-laws bf•Califarnia:" Signed ................... .......... _. Owner .... ...._.. ._.._.._.. T {hf:other than owner] s✓ � FOR DEPARTMENT USE ONLY r APPLICAT ' � ION ACCEPTED BY .. ... . .. .. ..... ..•- - - :._............-.............................................. DATE _.�` .�,� .:�.�.� .:....... ... . .DATE �: BUILDING` PERMIT ISSUED -�-•--•.,.............................•-----.. _.._....... .............•---...__...._.. ADDITIONAL COMMENTS ._..............................••---•-•---•--....__........_......-•-•----........_......... 4 t.................. .....................................................................................................................-. ......................................_.......... ................................._............ ...... ..._.:..__...--•---••-----•---•----..._.....-----•----....•-•---•--•---•-•-:._..••--•-•-••---------•--�----------------------------------- r _ . .. - - - Final Inspection by: ...:...... - --- - -- !{ I -•---- ---�... _ . ..-----••----•..................•-----......-------......-......Date ............... .._• ----•------..__._......SAN JOAQUIN LOCAL' HEALTH DISTRICT E. H.13 241-'68 Rev.-5M 7/72 3 �A ��