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FOR OFFICE USE: APPLICAJION FOR SANITATION PERMIT a s-..'`F"---------------------------- T f> et )-1 Permit No. _ :- -_--.---_-- r �T7 (Complete in Triplicate) I ----- --"''------------------------------------------- �. ------------------------------------------_.__--.------- � This Permit Expires 1 Year From Date Issued Date Issued -2" I 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: ATIONJOB ADDRESS/LOC .-- - --------A/------ _-CENSUS TRACT -------------- ----------- Owner's Name � 't -------Bee__s#----------------•-------- - -------------------------Phone -4 - ----------------- Address --- ---------_7J-� r--------/Pl�r�?��QV----------------------- City ' s' Contractor's Name ---//V ItF �----_� ,� Gp --------_--__-_.License #1 e-9..- Phone Installation will serve: Residence Apartment House[] Commercial ❑Trailer Court Motel ❑ Other Number of living units:- ____-. Number of bedrooms ---_ __-Garbage Grinder -- -_ Lot Size ------------- r Water Supply: Public System and name =------------------------------------------------------------------------ Private,,k Character of soil to a depth of 3ffeet- Sand'❑Silt❑r ,Clay_,❑ *.Peat❑ ,Sandy Loam .E] Clay Loom ❑ . _ Har4pan j< 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 Itank or seepage pit permitted if :blit sewer is available within 200 feet,} PACKAGE TREATMENT [ ] SEPTIC TANKM Size---7� �_j ---.--_--_.---- Liquid Depth - ------------------ Capacity/ !'. Type) Material ��l/�o. Compartments A-_______________ Distance to nearest: Well -----__37Z5__ ---------------Foundation ---____._--_ Prop. Line ...... u LEACHING LINE D No. of Lines 1�z------------ Length of each line --- Total Length - i D' Box ti C Type Filter Material 4P49Z, <__Depth Filter Material _-!'7 ---------------------------- Distance to nearest: Well --: - -------- Foundation .f - Property Line --_---__.._...._-- I SEEPAGE PIT, De th --`- Number - � p ----a�+.1--_-___ Diameter ��------ ----�.---------------- Rock Filled Yes No i❑ Water Table Depth _ -. -------------f-_--.-_--•-___---Rock Size `/----------- Distance to:nearest: Wel l ------_ a ____----------------Foundation ----f0--------- Prop. Line------------•---- l REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date -_-----_-----__-_----__--__-_..__-) Septic Tank (Specify Requirements) ----------------------------------------------------------------------------------------------------------- ----- Disposal Field (Specify Requiremants).--------------_-_____----_- -------- ------- ---- ----- -- -- ,—. ,..-----...r te_ ----------------------------------------------------------- '". (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 subject to Workman's Compensation laws of California." Signed ----------------------- ---�_ o - -- ------------ Owner By ----- --------------------------- :---------------. Title __-eall-MlO Me (If other thwner) j FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY _ -----------_ { -- ------ --- ��DATE ..--.. _/7-SIX? .-------------- BUILDING PERMIT ISSUED ATE -------- --- ADDITIONAL COMMENTS -------------- ------------- --- ------------------------ ------ ------------- . -- ----- ------------------------------------------------------------------------------------------------------------ ----------- o ------------------------- ------------------------------------ --- ---- ----------------------- Final Inspection by: y''�' fl---------- -----------------------Date SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M -