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FOR OFFICE USE: r ` r APPLICATION"`FOR�ANITATION PERMIT ---------- -------- ----------------------- Permit No. (Complete in Triplicate) %° This PermitExpires•1 Year From Date Issued Date Issued _(11.x-____'__.d ------------------------------------ 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: I JOB ADDRESS/LOCA ON ..-------1 _ -4/--._ _✓` 1_----------��`�o.-'' ..........CENSUS TRACT --5- - -------- Owner's Name ........ Pyr-r` £- <5'2`' ------------------------------- --- -------Phone Address --------------- ------------------------------------ Cit 14 __ Contractor's Name __._t1-i �l�i -r - L c� ------.License # --------- -------------- Phone --------------------- -------- Installation will serve: Residence ❑ Apartment House❑ Commercial ❑Trailer Court I❑ 1 l Motel ❑ Other ------------------------------------------- Number of living units:._'_J.____ Number of bedrooms _U------GaZol ge Grinder ___________ Lot Size /111_X_3 _,_______________ Water Supply: Public's st # 4 � pP Y� Y em and name --------- ---u-- -� ------•--- -`' --------------- ------------------------------- ----------------Private ❑ Character of soil to a depth of 3 feet: Sand'E4-`�ilt❑ Clay ❑ Peat ❑ Sandy Loam ❑ Clay Loam :❑ FHardpan ❑ Adobe'❑ Fill Material ------------ If yes, type _.________.________________ - (Pl'ot 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 seeps 'pit permitted if public sewer is available within 200 feet,) ..__ , .,, PACKAGE TREATMENT [ ]' 'S1=PTIC TANK [ p �Size-------------- Materiah_Ce�C�"�_• -------- Liquid Depth ___�__ _______________ � ! elm• - Capacity 1/,,2&0-_ Typ No. Compartments _____� (� ! i ----- kDistance to nearest: Well __________` __________._=_---Foundation ____1.0`_______ Prop. Line ---�t�a_ _______ LEACHING LINE [ of Lines __ ________________ Length of each line._.__r1C�l _ Total Length ,___ 117-------------- r-___`N0. - --- 'F ' Q' Box _cya__..r Type Filter Materia L��- _Depth Filter Material /_q�-_______________ r a ' Distance to nearest: Well ---- -------------- Foundation --- ----------- Property Line _�.�.----_-__._____ SEEPAGE PIT [ ) Depth -------------------- Diameter ______-_-______ Number ---------------------------- Rock Filled Yes © No 1 Water Table Depth---=---------------------------------- - ----- -Rock Size ----------------------------- - Distance to nearest: Well'_c--------------------------------------Foundation -------------------- Prop. Line -.------.----------_._ REPAIR/ADDITION(Prev. Sanitation Permit# -------- - ------ _ -- ---------------------- Date ------•---------------------------� SepticTank (Specify Requirements[ --------------------------------------------------------------�---------------------------:----------------,----------------------------- Disposal Field (Specify 'Requirements) ------------- ----••--------- --------- ------------------------------------------------ I -------------------------------------------------------------------------------------------------------------------------------------------------- ----------------------------------- ---------- ------ f (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: "1 certify that in the performance of the work for which this permit is issued, I shall not employ any person in such manner i as to become subject to Workman's Compensation laws of California." r Si�ned -----------_ I { Owner ------------------------------------- - . e ? ------------------------------ Title --------- ------------------------------------ ------------------------- (If other than owner) FOR .DEPARTMENT USE ONLY APPLICATION ACCEPTED BY _.____ ._� ��--_ &9------------- - --`--- ---`- -- - -----------------------------------=---------------------� DATE.----��.-'----- BUILDING PERMIT ISSUED --- ---------DATE ...-- ----------------------------- ADDITIONALCOMMENTS ------------'----------------------------------------------------------------------------------------------------------------------- ------------------------------ -- ---------- ----------------------------------------------------------------------------------------------------- - - ------------------------------------------------------------------------------------ �.,-. . L - { ---------------------------------- - -------=------- Final Inspection by: --------------Ny--- ----------------------------------------------------Date -� 1_- G----------------- SAN°JOAQUIN.-LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M,