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_ FQR OFFICE USE: t APPLICATION FOR SANITATION PERMIT --------------- ~- ----- -- Permit,No. q_1 -- -------------------- w (Complete in triplicate) ' ----`---------------------- ------------------ Date Issued -------'----------------------- _--------------- This Permit Expires 1 Year From Date Issued 3-w -a-- ---• 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 exi ti g ides and Regulations: JOB "ADDRESS/LOCATIO ------------- --- - --�=: ---4 - -- /� ~� -- --------- SUS TRACT Owner's Name - ------------ 5— �"�----------------------- ---------Phone.T --`-- - Address _-._ o S'- = `fir -------- - City --� ---� -'�`'..Gt. Contractor's Name -------- / �---------=-------.License # 14,;-`T_T-�-Phone 3.gyp ------------•- Installation will serve: Residence "Apartment House,F Commercial:❑Trailer Court i❑ Motel ❑Other ---- -------------------------------------- Number ------- ---------------- ----------Number of living units,------Z-__ Number of bedrooms ---:7----Garbage Grinder 0.._ Lot Size ----4�7Q. k,-- Water Supply: Public System and name ---------- - 4 Private ❑ Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam;❑ * Hardpan ❑ Adobe-;V 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 f ]FYI 1–� Size-----------_1----------------------------------- Liquid Depth --------------------------x' Capacity ----_ T F ---.---- No. Compartments P Y --------- - Type - -----'-'_-- Material------------ - --------------- t Distance to nearest: Well ------------------------------------Foundation ---------------------- Prop. Line ---•----.-----_ LEACHING LINE No. of Lines -f.3 f P [ Length of each line Total Length --------------- ; 'D' Box _A_0--- Type Filter Material --- ---Depth Filter Material ---ll-_r�--------_-----------------� Distance to nearest: Well -� _�-R7Foundation ------------- Property Line -_-15---.-----------._.-. SEEPAGE PIT Depth Diameter - __�_! Number __-- ---------------- Rock Filled Yes No ❑ I Water Table Depth ------ d-r------------------•-----------Rock Size ----c::� ^--------- Distance to nearest: Well ___�_"�_----Foundation --- _-r----- Prop. Line --- ... ......... R.EPAIR/ADDITION{Prev. Sanitation Permit# -------- ----------------------------------- Date -------------.__--_ i Septic Tank (Specify Requirements) -------------------------------------------------------------------------------------------------------------- ' r , Disposal Field {Specify Requirements} a_ -------- 'GcJ 0' ��e,� T. / rs-----�4------x------------------------------- q2-----------46_ ------ 1 E'_X 1 -------- " ---------------------- ------ -------------- ------------------------- - -- . . (Draw existing and required addition on reverse side) I hereby certify that C 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." f Signed -- Owner ' ----------- BY ---i _ _ Title ----------------- ------------------------- ---------- ! t• (If other than owner) xJ FOR DEPARTMENT USE ONLY - w APPLICATION�ACCEP�TEDY --- - -=------Bt111_DING PE ---- ------- -------------------------------------- - --------------------- -DATE ------------------------------------------- ADDITIONAL COMMENTS - ------------------------------------------------------------------------------------- ------- ---- - - ------- ----- - -------- ----------------------------------------------- -------------- ---- ----------------------- - - ------------------------------------------------------ --- ----- ---- ---- -- ---- ---- --- - ---- - - - - Final Inspection by: -- Date .-- --- -------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT E.;H. 9 1-'68 Rev. 5M C