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FOR OFFICE USE: APPLICATIG' ,FOR SANITATION PERMIT ' • Permit No. _.7y_-� y. (Complete in Triplicate) ------------------------ ------------------ _3_-i "�_.. --------------------------------------------------------- This Permit Expires 1 Year From Date 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 compliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION ------------- �` -6 `� S' r �"�'- -------------------------------CENSUS TRACT __.-- (� --------------------- Owner's Name -------------- � rid'_ C:-alr��j�-------------------------------------------------- ---- ---- -----Phone 3 7a 9 ------ Address l C ' 5 sf' -. l- .i'he' u/ ------- -----. City ----- Esc-'K�a- 1----------- ------------------ Contractor's Name ------------------ + -------------------------------------.License # ----- - i--- ---- ----- Phone ------------------------------ Installation will serve: Residence ❑ Apartment House,❑ Commercial :❑Trailer Court Motel ❑ Other ----- ! .......64-0,P of living units:------------ Number of bedrooms ____________Garbage Grinder ------------ Lot Size ----705--a '.__--_____________.___ Water Supply: Public System and name -------------------------------------------- ----------------------------------------------------------------Private Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam Xj Hardpan ❑ Adobe ❑ Fill Material __________ If yes, type ---------------------------- (Plot _________________________(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 seweJ—er is available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANKlfF ' casize____________ Qa __..___________ Liquid Depth 1 _.________.____ Capacity 400)-a_a 1_ Type S_0_r-4_I_`�trr_ Material--- No. Compartments ____�_______ _______ .. r f Distance to nearest: Well ----- _ Q__________________Foundation _____1Q___________ Prop. Line 2Y............_ ...... 0 LEACHING LINE No. of Lines ------------1.____..____ Length of each line----------*�_4------------ Total Lengths-----�d----------------- 6 'D' Box ------------ Type Filter Material ,rp-7_c_`5--9�n�epth Filter Material -------[V___________________7----------- to Distance to nearest: Well __._ _______ Foundation ----------- Property Line _._r _a-------------- SEEPAGE PIT [ ] Depth -------------------- Diameter ---------------- Number ________________________ Rock Filled Yes ❑ No 0 LA Water Table Depth ------------------------------------ -----------Rock Size -------------------------------- . Distance to nearest: Well -----------------------___-------------_Foundation -------------------- Prop. Line ________________--__.- REPAIR/ADDITION(Prev. Sanitation Permit# -------- ------------------------------------ Date _______________-__-______________) SepticTank (Specify Requirements) -------------------- -------------------------------------------------------------------------------------- ------------------------------ �. Disposal Field {Specify Requirements) ----------------------------------------V----------------------------------------------------------- ---------------�---�+ ------------------ -- -------------•--------------------091 --------------------------- --------- --- ----- ---- ------------------------------------------------------------- ------ ---- - ---- -------------------------------------- (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 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 subjet W mans amp sat' n o alifornia. Signed ----x---------- -- ----------- -------- ---------- Owner BY ----------------------------- Title ------------------------- ---------------------------------- (If other than owner) FOR PEPARTMENT USE ONLY APPLICATION ACCEPTED BY -------- - - DATE ----- - ---------- BUILDING PERMIT ISSUED __-___DATE .___._ ADDITIONAL COMMENTS ---------------------------------------------------------------------------------------------------------------- ---------------------------------- --- ------------ ---- -- -- --- -- -------^--`----------- -------- -- ---- - ---- -- --------------- -- --------- -- ----------------------------------------------------------- ---- O .4 -- -------- l 1 ate �-------------------Final Inspection by SAN J AQUIN O LTH DISTRICT t E. H. 9 1-'68 Rev. 5M