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rUK OFFICE USE: ................................. --------- APPLICATle')N FOR SANITATION PERMIT 7G-- �3/ (Complete In TAplicate) Permit No- ................. ... This Permit Expires t Year From Date issued Data Issued 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 - - .,..)erJ..........................CENSUS TRACT Owner's Name /Y._...Pa_j.7....--- ? ..Phone ... Address .......•..City .�/h�� ................ __ Contractor's Name �1 , 1 # ,f�. .� . Phone .. . Installation will serve: Residence Apartment House❑ Commercial❑Trailer Court ❑ , Motel ❑Other............................................ r I Number of living units:_..___-.. Number of bedrooms ......Garbage Grinder .ND.... Lot Size ,/.QQ ._..•-- ........ Water Supply: Public System and name `+A ..Private ® Character of soil to a depth of 3 feet: Sand❑ , Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ Hardpan 0 Adobe q 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 sid NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,¢ PACKAGE TREATMENT [ ] SEPTIC TANK j Size.--- �� -•S • _..•._. Liquid Depth ... ��1................ Capa"' `/*>00__..... Type ,l�e� Moterial.� - , No. Compartments ..A...--,-_••Distance=to-nearest: Well ' �� Foundation .11 ... Prop. Line ... LEACHING LINE ",--No. of Lines ..__ ______________"Length of each line_V Total Length ..I.M.'...._..... D' Box. Type Filter Material ../r Ocr -.Depth .Filter Material IV!!. Distant to'nearest: Well .... Q_...........Foundation /O................. Property Line ..S-l.............�11 SEEPAGE PIT (A Depth ----95..--... :Diameter ,_ -�...._ Number `:;-.. ....._ Rack Filled Yes-ID No . Water Table Depth �0Q-------------_--•--• -•---.Rock Size .�/�-.�� ...............- i Distance to neoresi: Well'...../D.Q_...... •,-- :%Foundatlon ......... Prop. Line . ............... REPAIR/ADDITION(Prev. Sanitation Permit# ................ .....•-_-:.. _. ..----_.--.Date Septic Tank,.(Specify,.Requirements),:._....-------•--------- -- ----------- .......-•-•-- ............:._ I Disposal Field (Specify' Requirementsl ------------------------------- --------- -- -- -------------------------------------------------------------------------------------•• [ ___________________y.________. _____________ ______ .................•-•_ { __---------___________________ ________________________________________________•__---_____......_.._-.----_--_.....--_-_.------__._-..-.-__-._--_.--- 4 _(Draw existing and required addition►on reverse sidel, r. Y 1 hereby certify -that f 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, 1 shall not employ any person In such manner as to become su/erthan or m n's Co nsa#' n laws of California." Signed ...... - `- . Owner BY . . , __._._----- Title - - -•-------- P .r (if ownerl i - DEPARTMENT USE ONLY { APPLICATION f ACCEPTED BY --. i -- ------------- ---------------•-•----------- ------• --•--•-----....---••-----.. DATE .��-��!...��.--•,�------ BUILDING PERMIT ISSUED ..-- -- .. _.- _ DATE .-- ADDITIONAL COMM--NTS • Qlff_- ------ ......... ........ .. ` ...._.. -•---- . --_ .._•.....-. -,__ = r..- Final Inspection b): -•_�, 2 .............Date .. .. ,! ER 13 2 1-58 V. AN JOAQUIN LOCAL HEALTH DISTRICT $/711 3M t