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FOR OFFICE USE: , APPLICATION A t OR SANITATION PERMIT ------------------ `"{coa y plete in Triplicate) ' -------------------------•-----------__-_. __.___ This Permit Expires 1 Year From Date Issued Date Issued I " 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: • ci . - GJOB ADDRESS/LOCATION -- - - Ale_Y014.1.__CENSUS TRACT -------------- Owner's Name ---->P -'-----�..� ------------ 4 ------Phone Address n_ e J /� Cit ---- -------------------------------------- Contractor's Name ------- �icense �`� a #�_�'L7'7 Phone ` _ ___ Installation will serve: Residence Apartment House❑ Commercial :❑Frailer Court ;❑ / Motel E]Other Number of living units:____,C___._ Number of bedrooms _�------- Grinder .___ I r ` �9� p Lot Size ---- --------------------"---------- Water Supply: Public System and name __ [ rC -------_----_- ---Private ------- --- -- -------------------------------------- Character of soil to a depth of 3 feet: Sand:ri;K Silt❑ Clay .❑ Peat E7] Sandy Loam .❑ Clay Loam:❑ -. ,� _ Hardpan E] Adobe E] Fill Material _-__y__ 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 Q Size - --------� � - Liquid Depth N Capacity olj".GiQL Type Al e4,a„�Material_ I r C'.o- e.ns� No.f Compartments ,--:............... Distance to nearest: Well ___`70_--__________________-_Foundation /-- ------- --- Prop. Line --- ---------- Qkl LEACHING LINE ,k No. of Lines -------7 Length of each line______ Q_---_---___ Total Length �'f _" .i D' Box __ ____ Type, Filter Material __ u ---_Depth Filter Material __---------------------------------- Distance ""_ a # ------------------------- 4-47 Distance to nearest; Well ___ _____________ Foundation _la---__------------- Property Line -_�__.---------------- SEEPAGE PIT [ Depth -----I_>-" _-----____.---_ Rock Filled Yes No (] _-__-- Diameter -�=-----_"""-- Number --____-- ' Water Table Depth ---1-\--------------------------------------------Rock Size �9ClA)C i! Distance to nearest: Well -------------------------------- ---" -Foundation •--------------""-"-- Prop. Line ..-----_---•- -- REPAIR/ADDITION(Prev. Sanitation Permit e# -`t----------------------------------------- Date --------•-------------------------1 Septic Tank (Specify Requirements) --------------------------------------------------------------- Disposal Field (Specify Requirements) ___________ __ --------------------------------------------------- ----------------------- --------- ----------- ------------------ ----------------- ------------ __--__..__________________________ (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 licen- sed agents signature certifies the following- "] 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." .Signed ------------------ Owner -------------------- ------------- --- - BY ----------- ------ ----------------- -- -Title ---- other than owner) -- -------------- - - ---------------- - F DEPARTMENT USE ONLY APPLICATION ACCEPTED BY -"-___"" 7 BUILDING PERMIT ISSUED _________________ ------- ------------ ------------------------------------ DATE -- J ADDITIO NAL COMMENTS ;__-_________ - ------------------------------------------- DATE ----------------------- --------- ------------ ------------------------------ ------ ------------- ----------------- - ----------- -------------------------------------- --" --- ------------------------------ ------- ---------- ---- ------ `r - - - -------- Final Inspection b - +� � - - -1-------------- ---------- ate SAN:JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M '