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FOR OFFICE USE: - APPLICATION FOR SANITATION PERMIT (Complete in Triplicate) Permit No: ---G4--_/6)y•.� --- -------------------- --------------------- This Permit Expires 'I Year From Date Issued Date Issued ._y- 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: JOB ADDRESS/LOCATION -..,e%IIU�U _ ---- .__ .../` e ----------- -7 `l-_---------CENSUS TRACT Owner's Name _---------- 1PAC,;'.. 1''�.2, - -- - - ------------- --•- ---------- ---- ------------ Phone ----�3�y�fa-�------ Address ----------- 45 _ Ll� = tr City --� f Contractor's Name --------------- - -I_C---------------------------------------License # - ----------------- Phone ------------------------ installation will serve: Residence rr%,partment House,[] Commercial :❑Trailer Court ',❑ Motel ❑Other---------t----------------------------- Number of living units:-.._/----- Number of bedrooms ----L.----Garbage Grinder ---_---— Lot Size .- 6"'?Q O®G'!o F Water Supply: Public System and name --------------------------------- ----------------------------------------------------------------------Private E}— Character of soil to a depth of 3 feet: : Sand'❑ti Silt y ❑� E1. Sandy{Loam.Q- , QciyAoam:❑; l t depth f 3 S El �.Cla _ ' Peat Hardpan —Adobe -0 Fili 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 Q�f Capacity P,C TANK [ Size--------1V�-..-lr --___------_ - Liquid Depth --- - ---- ----- Distance to nearest: Welle--------- _ - Material�.G.i��-- No. Compartments _.'Z...�----------- _..__.. - yp V i - b - Foundation _:1Q--------------- Prop. Line .---�----=-------- LEACHING LINE [ ] No. of Lines --------/------------ Length of each line-------8C--------------- Total Length -------U.)------_ 'D' Box _—_.._ Type Filter Material - ----Depth Filter Material .___- - -s�-------------- 'to�- "�'e'Distancenearest: We � 5 i -T- - - -- - Foundaton __749------------ -- Property ine -- L - --------------- SEEPAGE PIT [ ] Depth --------- ---------- Diameter ---------------- Number .-....__----- -- Rock Filled Yes ❑ No i❑ Water Table Depth ------------------------------ ------ --------Rock Size ------- Distance to nearest: Well ----------------------------------------Foundation -------------------. Prop. Line .......... .......... REPAIR./ADDITION(Prev. Sanitation Permit# ._..__.._--_..__._ ----- Date Septic Tank (Specify Requirements) ----__----- Disposal Field (Specify Requirements) ------------------------------- ----------- ---------------------------- --------------------------------------------- ---_-- raw 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 I County Ordinances, State Laws, a d les and Regulations of the San Joaquin Local Health District. Home owner or licen- sed agents s' not cth er ' es e wing: "I certify a rm n o the work for which this permit is issued, I shall not employ any person in such manner as to bec bje o r n' om ensation laws of California." Signed _.-- --- -- ------------- Owner ' ------------- By -------- --- --- --- Title - - -------------------------------------- (If other than owner) ----------- -------------- ---- --------- ---------- FOR --------- ------------- ------------ ---------- FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ___-_- -_---__------------------ - ---_ , DATE ___.7�`��- -__ __ , - - ----------------------------------- ---- -- --- - - LD1NG PERMIT ISSUED _-___. _________--_ _ --- -------------------------------------- _DATE ---------- ADDITIONAL COMMENTS ----- -- ---------- ------- ----------------- ----- - ------------------------------------------------------------ Final inspection by: _ - ------------------ ------- ----------------------- ----------------- - --- -------- ---�- -- _.._---_Date - - --------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M.