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FOR OFFICE USE: '\PPLICATION FOR SANITATION PES ----------------------------------- ------------------ (Complete in Triplicate) " - Permit No: p p Da -----____- This Permit Expires-I Year From Date Issued to 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 i_ r a�e in compliance with County Ordinance No. 549 and existing Rules and Regulations: i JOB ADDRESS/LOCATION .__ '� - ®•-- C7_--f ------------ - -----------CENSUS TRACT --------------........... . Owner's Name .-#' " -... •�'P Addressl,el, Phone _ �� . •-•- -------•----------•--•- ------- � - --�--- -Contractor's Name - - � # _«Z.6�-.4�-JPhone _.�-=----------�f•�-....fes.. Installation will serve: Residence [gApartment House❑ Commercial.❑Trailer Court ❑ i Motel ❑Other -------------------------•-----•-•--•---•-- f Number of living units:----..---_-. Number of bedrooms __-. __Garbage Grinder --2Z4174, Lot Size ....................................._-.__ Water Supply: Public System and name --------------------------------------------------------------------------------------------------- --------Private Character of soil to a depth of 3 feet: Sand V Silt❑ Clay .❑ feat❑ Sandy Loam •❑ Clay Loam + Hardpan Adobe 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 [ 3 SEPTIC TANK' Size-_-_,/ 6_a------glee----.----- Liquid Depth ---------.-_-.-•-..___-_ Capacity � QQ-------- Type -_e<Le�Material_ 'f-- _ __--_ No. Compartments ___�.•.-•------•--,- Distance to nearest: Well -_-46D- !S` '- --- -------------------Foundation -- -� '_ Prgp. Line -�---•�.,,�--- C LEACHING.LINI; [' j No. of lines _--_-__----- Length of each line----_70--------------- Total Length : 1�,6.._..__________ C. 'D"Box __ ------- Type Filter Material ��a;tD th Filter Material YP eP ----- Distances.,to nearest: Well _--- ..... _ Foundation ________fQ_----------- Property Line .._ --------------- SEEPAGE PIT [ j Depth Diameter ____ Number ------------------ Rock Filled Yes No wateP-iolble Depth -----------------------f-------•••-• ......Rock Size ----A;i -------------- Distance to nearest: Well ......---------------•---•...........------Foundation -------------------- Prop. Line ............. .-.._--- REPAIR/ADDITION(Prev. Sanitation Permit=# ------------------------= --------------- Date ------------------- .......... Septic Tank (Specify;Requirements) ------------------------ --------------- ---------------------------------- --------- - .<------------------ -------- Disposal Field (Specify Requirements) --••--------------- -------------------------------------I---------••-----•--------------=------------------------------------------- --------- (Draw existing and required addition on reverse.side) I .hereby certify that,I save prepared this application and that the work will be done in accordance with San Joaquin County Ordinances, Stc'tte 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 pe,formance 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 ----------------------- (if other tha owner} FOR DEPARTMENT USE ONLY APPLICATION.ACCEPTED BY_ .- __- - -S-------M-- i - --- ----------'I�l�.,�-- --------------------...----------• DATE ---•---�'L---��--�--71------....------ UILDINGPERMIT ISSUED ....--------------------------- - - --------------------------------------- -------•--------------DATE ------------------------------------------- ADDITIONAN COMMENTS ------------ ---- = - ---------�--�------alp _�._s-�t_�=� -------------------------- -----------•------•------------------------------------------- ------- ---------------------------------------------------- ------------------------ -- _ Final Inspection by: ----- ----- _-Date �v-� y SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1'-'68 Rev. 5M