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FOR OFFICE USE: ------------------------------------------------ ---------- ----- ---- ----------------------------- APPLICATION FOR SANITATION PERMIT (Complete in Triplicate) This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Health District for a per to con described. This application is made in compliance with County Ordinance No. 549 and =7-- p74 - 7 -JOB ADDRESS/LOCAION _/i'- Owner's lt-.ES/Q�i1 Name ea� t�/lei-------fjfll/y_ ---------------------------------------------------- --------- Address Zvf� ,el ---- r�3------------------------•--- Cit S Contractor's Name --_ A - fi t - --_e---S ��_� ' /. --------- #oe Installation will serve: Residence ❑ Apartment House❑ Commercial ❑Trailer C Motel X"the,,*AUtF---- A?®,17`"'----- i /��''n Permit No. _e1 ----------- Date "__ ._Date Issued struct and install the work herein existing Rules and Regulations: IM CENSUS TRACT ---- --- Phone ___ ---Phone ------------------------------`------ ----- Phone 11 ourt ❑ Number of living units ------ Number of bedrooms ---- Grinder ------------ Lot Size -_-_-_-------------------------------- Water Supply: Public System and name---------------------------------------------------------------------------------I�------•-----•------•--------Privatex Gh Character of soil to a depth of 3 feet: Sand' ❑ Silt ❑ Clay ❑ Peat Sandy Lol� m -E]Clay-Loam Fj Hardpan E]Adobe ❑ Fill Materia ----- 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 Size_ X_,57_ �9__'__._____1p ____ Liquid Depth T__________________ i _ 21-1Capacity/R07G_____--__ Type lg° c#sj- Material ------ No. Compartments �._ Distance to nearest: Well�(_______ _____ ------------ Foundation ��__f/k_` Prop. Line LEACHING LINE [ ] No, of Lines _________- Length of each line --- c;le______________I�__ Total �Q_-_}�C?____.___ 'D' Box ---- /---- Type Filter Material __~7� 6 Depth Filter Material _�i________________________________ Distance to nearest: Well ________________________ Foundation ----------------- _I`�----- Property Line. __________________--____ SEEPAGE PIT [ ] Depth -_---- Diameter ------ ---------Number ----------------------- 11 Rock Filled Yes ❑ No:i❑ Water Table Depth ------------------------------------------------Rock Size --------- `I-`---------------_ Distance to nearest: Well ----------------------------------------Foundation ------ �l``------- -._-- Prop. Line -•-.----..------__---- REPAIR/ADDITION (Prev. Sanitation Permit #_•-----•------------------------------------ Date------------------I�_-------------- ) Septic Tank (Specify Requirements) ____--/"1 - --- - - - - --- - --- ---- ---- - ---------- ------------- p ------ ------- Disposal Field {Specify Requirements) _-, 6,11-1 ------ '`�---------------�jd-------r-_____�--------- �---- _------------------------------------ I--------- y -------------------------------------------- (Draw ------- '______________________________(Draw existing and required addition on reverse side) e 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 He Ith District. Home owner or licen- sed agents signature certifies the following: 11 "I certify that in the performance of the work for which this permit is issued, I shall/`not omploy any person in such manner as to beco a suWect to W kma 7 Compensationjnrs of California." Signed --M3 .7 f -e ---- -d �%- �• Owner ti � - --------- BY. .. Title ------------------------------------ (If other than owner) F DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------Z_�- --- ---------------- - ��. DATE----/�-r7 -/ BUILDING PERMIT ISSUED .-------------------------------- ----------------------------------------------------!--DATE -------------•----------------------------- - - -- - ----- ADDITIONAL COMMENTS - ----- -------------------------------------------------------------- 1M------------- ------ - - - - - - -- - - - - - - - - - - - - - - -- - - - - - - - - --- - -- -- - -- - - - - - - - - - -- - - - - - - - - - - - - - - - -- - - - - - - - - - - - - - - - - -- - - - - - - - - - - -- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - ----------- ---------------------------- - ------------------------------------------------------ ----------- -- f- - Final Inspection by: ------------- --- ----- ---•-------------------------------------1`1`--.Date- -�� fsf� ----------------- SAN JOAQUIN LOCAL HEALTH DISTRICT �I / E. H. 9 1-'68 Rev. 5M