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t FOR OFFICE UaE:30 Y APPLICATION FOR SANITATION PERMIT �y t Permit No: dUd . . �� v (Complete in Triplicate) �_ -----------------"---------------- F ` _______________ This Permit Expires 1 Year From Date Issued Date Issued &-n�_--�tJ 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 mpdmpliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION . !l �1T,�� ----------------------- ------ ------------------CENSUS TRACT -----------•---------- Owner's NameErE` -------/i-- ?lv ��Zlwn-----------------------------------------------=- ----------------- -Phone - Address ---��i-a /---------�� ,� ------------j'-a---- City . Contractors Name -----•-- !---------------------------------------------------------------License # /7�.. Phone -'f�. -- - Installation will serve: Residence X Apartment House❑ Commercial :❑Trailer Court 1❑ Motel ❑Other -------------------------------------------- Number of living units:----f_____ Number of bedrooms _-cz`Z------Garbage Grinder .��---- Lot Size _� ___/30 -----------------•-------- Water Supply. Public System and name ---------------------- ------------- ---------------------------------•-----------------------------•---------Private ❑ �.Character of soil to a depth of 3 feet. Sand'❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam .n Hardpan ❑ Adobe I? Fill Material ------------ If yes,type _ _______________________ (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 sewer is available within 200 feet,) PACKAGE TREATMENT `-------=----.. } [ } SEPTIC TANK�i]' - Size----��f�------------------•-- Liquid Depth ---�'-�-r-�-- '�.. Capacityle7e.61.0A Typeo�_, ___ Material�fX/ No. Compartments ; ................ Distance to nearest: Well -----' `C%'__ --------------Foundation __fO-------------- Prop. Line -.%-_r_____,�_.._ 1 LEACHING LINEf N o, oLines [�I -----1 ______________ Length of each line---/_e-0-------,--------------- Total Length ---------------- t . -- - - 'D' Box '_0-` Type Filter Ma#erial.._ .QK�_�_____Depth Filter Material ___ ---------________________________ Distance to nearest: Well __.__�P.--__-_ Foundation _--le`_____________ Property Line �:f ._-._-.__._._.___ SEEPAGE PIT Depth ___�.�"____ Diameter -c3�_____ Number --____.l_ ______ Rock filled Yes W No 0` I Water Table Depth __. G- --- ----------------------------- Rock Size _1_l-le-- Water I ,J Distance to nearest: Well .-._/MD---7--------------------------Foundation ------ Prop. Line __ --------------- REPAIR/ADDITION(Prev. Sanitation Permit Y# -------------------------------------------- Date _---------------------------------) t Septic Tank (Specify Requirements) --- ------------------------------------------------------------------------------------------------------------ Disposal ----=-- ----------------Disposal Field (Specify Requirements) ---------•----------------- --••-------------------------------------------------------------- --------------------------------: ------------------------ ---------------------- ----------------------------------------------------------------------------------------------------=------------------------ ----------------------------- herebycertify that I have prepared this application cation end required addition 1 dition on reverse side) Y P R PP a 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: K "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 become7sub* ct�t;AZrkrngn's'Compensation laws of California." �/%Signed - ----- Owner BY ------- ------------------------------------------ ----------------- - ------------------------------ Title -- ------------------------- (If other than owner) OR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ----- - DATE __ -� BUILDINGPERMIT ISSUED ----------- -1-------- --------------- -------------------------------------------------------- ---DATE ------------------------- ADDITIONAL COMMENTS ._.__.______._ /11- --T------_:a:-: = __::::_: �__:_ _; :✓ _::==7 ----- ------------------------- ------------------- ---------------------- - --------------------------------------- --- -- - ---------------�NJ -----------Final Inspection by- --- - ---- - ------------ ----- -----------------------------Date SA"(JC OA IN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M.