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FOR OFFICE USE: -` APPLICATION FOR SANITATION PERMIT --------------- -------------------- -------------------- Pe . �f// (Complete in.Triplicate) rmit No. �J----------------- ----------------------------- --- r --------------------------- ------------------------ This Permit Expires i Year From Date Issued Date Issued ------ lQ-- -� 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 ---- �vcf,,' L _..--------CENSUS TRACT -------------------------- Owner's Name ----- �a_.-'/ '� 1�----- C_ L'? s-------------------------------------------- ---- --------------Phone ----------------------------... ' Address -------------------- - 3 ------f`'h_t -rr cx.,_—------ ------------ Cit i QS----------------- Contractor's Name ---I`-fl ------- ___- 11 _._._____ License # pf_ _1'_L Phone z =---------------------- Installation will serve: Residence [Apartment House❑ Commercial :❑Trailer Court ❑ Motel ❑Other -------- ----------------------------------- Number of living units-------- Number of bedrooms __3----- Grinder _ SLot Size _ n Y?-,z s Water Supply: Public System and name -------------------------------------------------------------- --------••--------------------- ----------------Private Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat ❑ Sandy Loam -❑ Clay-Loam 0 Hdrdpan ❑"' Adobe" , Fill Material'_;.tom If yes, (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 PT Size-- . - / r - Liquid Depth u._� 40 Capacity ----- Type afien a _ }� No. Compartments Z Distance to nearest: Well -- Foundatin ____.__oProp. Line `---�. LEACHING LINE No. of Lines --------�_________ Length of each Total Length ------- 'D' Box _y`0___5__ Type Filter Material _A�r_________Depth Filter Material Distance to nearest: Well ___- --------- Foundation ----------- Property Line_ _____ SEEPAGE PIT [ Depth -s-'7--r _,___ Diameter `'___ Number __Q -._.-.�-_-__ Rock Filled Yes -No C3 E Water Table Depth --------fctt--r-----------------•------------Rock Size ------- --------------------- lVd � . Distance to nearest: Well --------------------------•-- __ --- --Foundation --- Prop.Prop. Line ---------•----•....... REPAIRJADDITfON(Prev. Sanitation Terfnit# -------1----------------------------.------:.Date-------------------------- Septic Tank [Specify Requirements] ._�"r""" - - ,..- i Disposdl Field (Specify Requements) ------------------------- -----------------------------------------------t_ - --------------------------------------------- - 1------------------------------- .y (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 liven- 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." M� !Signed -------------------------------- / J ------------------------ Owner ;By ------------ ------------- -- -- _---._._ 4✓, -_ Title -------�._ - ---- -- - -------------- (If other than er] . FOR DEPARTMENT USE ONLY 'APPLICATION ACCEPTED BY:- --- -- ` ---`` - --- ----------=` DATE s BUILDING PERMIT ISSUED . f ------------------------ -------------=--------------DATE _..---------------------------------------- ADDITIONAL COMMENTS ------------------------------------------ ' - ra --------------------------------------------- - Final Inspection by. ------ ------ R' Date . '. --------------- --- ; -------------- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M. `��"