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FOR OFFICE USS: ' APPLICATION FOR SANITATION PERMIT -- -- --- -- Permit No. ---------------- (Complete in Triplicate) This Permit Expires 1 Year From Date Issued Date Issued --------------------- ---------- ----- ------ Application is hereby made to the San oaquin 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: JOB ADDRESS/LOCATION .L�.11_L Ed,__s -_.� 5,.�_RPH --------------------_R_1PQ_i'__.CENSUS TRACT ----- ---------------, Owner's Name ._ ,-I-7-- �q-� •- �J _�i IJ ----kEEA--- L_ -_ - 'fat-C�t _t< Phone - -_ .1-P ---- -------------- ------ ---------- �Address � 1$Contractor's NameQ ------ _- # --------- --------`-F'''-- Phone __ . . Installation will serve: Residence ❑Apartment House ❑ Commercial ❑Trailer Court 1E] r r + i Motel #)ther QRE-FN------R�STR00Wl l Number of living units:-----`"r_ Number%f-hedrooms --- -_____Garbage Grinder -----__._ Lot Size 60-4-.F----C-O0R [ .>�__ . Water 5uPPIY Pubis System an name Private Character of soil to a depth of 3 feet:', SandSilt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam E] rl fardpan ❑ Adobe ❑ Fill Materialif yes,type ---------------------------- (Plot ________.__ __[Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side,l` NEW INSTALLATION: (No septic'tank'or seepage pit permitted ' �Slloewer is available within 200 feet,) PACKAGE TREATMENT [ ] zSE�PTIC-TANK:[�-12,0d -,- Size �__-r___^_______________ Liquid Depth ------ ____f�_��______- I Capacity__ Type J , 5_.Material- ar - No. Compartments ____.......___- i It r r Distance to nearest: Well ------------------ 0__"F---Foundation -------------/0--- Prop. Line ._..________�— LEACHING LINE [ ] No. of Lines.-- -___.— Length of each line---- ----------------------- Total Length ____-_-----.---._._.___.__.. `D' Box ____ '_,_ Type Filter Material ---__---___--___Depth Filter Material --------------------------------------------- \") Distance to nearest-OVell, ----------------- ----- Property Line _______"___ _ ....... e ' SEEPAGE PIT [ Depth - _---_----- - Diameter _ Number ---------/---------------- Rock Filled Yes No Z Water Table Depth _ '�")_________��—_---Rock Size , L4- r Distance to nearest: Well -------- --410P....... `-------Foundation --------EQ------- Prop. Line .......5_________.. REPAIR/ADDITION(Prev. Sanitation Permit# ______________ _ _i____4--� ��-_Date5- ___ _____--__-._-________________) Septic Tank (Specify Requirements) ----------------------- > -- {--------------l - - Disposal Field (Specify .. ,. ., •, } Requirements) .-----' _C--- '------ F ......K C\ t/e � 3 n;.,3 i 1 v, t.i C� -------- --------------------- ------------------- --------------------- ------------------- --------------------- ------------------------------------------------- ----------------------- (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 JoaquI County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner or licen7\ 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 b me subject to Workman's Compensation laws of California." Signe C c�`'j - `-C� ---- ---,'tel{ S Zi%=f- --------- Owner BY --------- -- -------------- --------------------------------------------------------------------------- Title ----------- ---- ------------------------------------------------------- (If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY -----1--- B` "-----------------------------------------------------------------------. DATE BUILDING PERMIT ISSUED ------------------------------------------------ --_---DATE --------------__ ---------------------------------------------------- --------------------------- ADDITIONAL COMMENTS ----------- - ---- ----- - ---- -- -- -- ---- - --------------- --- �-- - --------------------- ------------------------------------------------------------------- -------------------------------------- ------------------------------------- ---- --- ------- --------------------------- -------- Final In ion by: Date SAN JOAQUIN LOCAL HEALTH DISTRICT v E. H. 9 1-'68 Rev. 5M