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FOR OFFICE USE: ]i (0"*4PPLICATION FOR SANITATION PEP'%%IT �� i �. -------------- ----------------------- pTriplicate) Permit No: _� __�Z . (Complete in i ---------------------------------------------- F- --------------_-.____-____.__.______--------------- This Permit Expires ] 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 hereir, described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION .___4rW f'_1__,_.1_Ct.Y/')'l_,S•___ - _7Q__ __ _.. f"T CENSUS TRACT _S"y ___.______�... Owner's Name ----------------- ---------------------------------- -------Phone -------------- ------------------ - n !, t Address 7 ' 1z C City -- 1 '-/- -Contractor's Name _-- 1?�-_- �' -- -l-�tY-----------------------------------License #2&a_F14� Phone t t Installation will serve: Residenceartment House-❑ Cornmercial ❑Trailer Court ;❑ Motel ❑Other •--•------------- Number of living units:-----4____ Number of bedrooms Z------Garbage Grinder ------------ Lot Size __________________________________________- i Water Supply. Public System and name .-_ ______Y -------- --•---------------------------------------•-------Private K4-, (A ea� Character of soil to a depth of 3 feet: Sand'❑ Silt E] Clay &— Peat E]�e5Sandy Loam 0 Clay Loam ❑ Hardpan .. � dobe Fill ' P � �� ❑ Mpterial ------------ if yes,type ---------------------------- (Plot -------• ------------------(plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) v P . .g P P � � NEW INSTALLATION: [No septic tank or se.ep...a e - lir- ermii'fed-if" �ublic-sewer is available within 20a feet,) . .� 1 PACKAGE TREATMENT ( ] SEPTIC TANK f ] Size------/220-0.414-1_____________ Liquid Depth .._..._:. Capacity ��00 ype "" cter�al�_ ._Ct_-�t� No. Compartments f1i __�.:.:.......... rDistance to nearest: Wel) _"_ w__ _____________Foundation_- ___________- Prop. Line ___ _. ......._ LEACHING LINE [ ] NDb. of Lin e Filter Material of eegch line'--- ___ _ C)_____ - Total' Length ___t"2-Q_____...... Length YP pth Filter Material ----- -------- i //ff Distance to nearest: Well A/00-------- Fourvdatiori ____ ��__ Property Line. _�_p__._.:.___ SEEPAGE PIT5-De th _-- Diamef 1. P -- - - - Vier "�_3_____ Number _-_____�--2222_ __ hock Filled Yes Flo i❑ i f 11 f Water Table Depth --------�:0 ---_=_ Rock Size -:---:/2__------,.,,.:.--- t Rock - Distance to nearest: Well ___-__ _© __________________Foundation �_�_-._..- Prop. Line .__-.._ REPAIR/ADDITION(Prev. Sanitation Permit# --------------------------------------2222-- Date -------------------......... .2222-) i - ' Septic Tank (Specify Requirements) --------------------------------------------------------------------------•-------------------"-----------------•---------- ------------- DisposalField (Specify Requirements) ------------- ----------- ---------------------------•--------------------------------------------------------------•---,.._-..----- ----------------------------•--------- --------------------------------------------I-------------------------------- ----------------- - ----------------------------------------------- -------•-•------- ---------------------------=------------------------------------------------------------------------- ;. [Draw existing and required addition on reverse side) ! k 1 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: f "1 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 G - --�---------------- -Title ----------- oVV�_G__--�l.__•-- {Ifo r than owner) FOR .bVARTMENT USE ONLY t , APPLICATION ACCEPTED BY . --------=------------------------------------------ ------. DATE _/ ._'r�-`�'�,3------------- BUILDINGPERMIT ISSUED ------------------------------------------------------ ------------------------------------i--------------DATE ------------------------------------------- ADDITIONAL { COMMENTS ------- ----------------------------------- ----------------- ---- --------- a --- --:------- -- -- ----------------------------- I -- - - -- - Final Inspection by: ---- -- ------------- ate � - ------ ----- SAN JOAQUIN LOCAL HEALTH DISTRICT 1 E. H. 9 1-'68 Rev. 5M