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FOR OFFICE USE: APP-LIC-47-ION FOR SANITATION PERMIT jj qq ----=------ -- ------ ------------ __tP_l.`S__�. (Complete in Triplicate) Permit No. ---------------------------------------------- _ -------------- This Permit Expires 1 Year From Date Issued Date 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 --- 1 _� / 1-� c�- e-----41-- - ---------------- /� - CENSUS TRACT -------------- ----------- I Owner's Name l nil — ----- ,(1 tIL I --f--�-- 0------------------ -- ------- --- .446-Phone S 7:.1_ J07------ Addressfi ------ 0----------------------- city..--------*--------------------------------------------- Contractor's Name . a-�Cli.'Q-- -------------------------------------------------- --------License # ------------------------ Phone ----------------------_ Installation will serve: ResidenceRf Apartment House Commercial :❑Trailer Court ;❑ Motel ❑ Other ------ ------- s -ate . Number of living units:--- Number of bedrooms 2_Garb ge Grinder AO---- Lot Size _ _ '-. �-b__________ Water Supply: PublicSystemand name -- ter.<�v_ -- -P-.....(-AZc//--------------------------------------------------------Private ❑ Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat❑ Sandy Loam -❑ r Clay Loam X Hardpan ❑ Adobe ❑ Fill Material ------------ If yes, type __________________________ (Piot 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' f SEPTIC TANK [ ] Size__ S ��r_�X �.________ q p y�--------- Liquid Depth ...... d i Capacity _,-'2Z90------- Typej ry --- Material_�_cr_44 -No. Compartments __�,�______________ 4N Distance to nearest: Well ---la-0------------------------Foundation Z-0-------------- Prop. Line ___Ili______________ LEACHING LINE No. of Lines -. _______________ Length of each line-----S-00--------------- Total Length .___ ------------ D' Box i--__- Type Filter Materials -------Depth Filter -Material -------Zg`Y____.____---�.._____- Distance vto-nearest: Well ------- Foundation __49P_--___ _------- Property Line _____0___ _________ SEEPAGE PIT [ ] t +' Depth --- -------- Diameter Diameter ________________ Number ---------__._-_ _~'_------- Rock Filled Yes ❑ No IQ Water Table Depth ------------------------------------------------Rock Size ----- --------------------•---- Distance to nearest: Well ----------------------------------------Foundation -------------- ---- Prop. Line ---------------------- REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date -------•---------:------------ Septic Tank f Specify Requirements) -------------------------------------- ------------------------------------ ----':------------ ------.------- Disposal Field (Specify Requirements) ------------------------------------------------------------------------- -------------------------------------------------------- ---- ------------------------------------------------------------- -------------------------- -- - ------------ - ------------------------------------------------------------------------------------- Cull00� �- .5',- -., ,�- -------L--------------- ---------- ----------------------------------------------- (Draw existing and re fired addition on reverse side) I hereby certify that 1 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 bec subject to man's Compensation laws of California." Sigd . L- -------- --- --------------------------- Owne BY = Title -- ------ (If other,t n owner) is FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---- -- BUILDBUILDING ING PERMIT ISSUED --------------------------------------------------------------- -----------------= -------DATE ------------------------- ----------------- ADDITIONAL COMMENTS ------- ------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ---------------------------------------------------------- ------------------------------------------------------------------------------------------------------------ ------------------------------- Final Insection b r r P Y- ----- - - -------------------------------------------------------- ---------------------------.Date --- --- ----------- SAN JOAQUIN LOCAL HEALTH DISTRICT ; E. H. 9 1-'68 Rev. 5M '