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rvrt vrrii.c wc: APPLICATION FOR SANITATION PERMIT 171—sq-7 F (Complete in Triplicate) Permit No, ............... ..........=--------- ---------- -7 4 Dote Issued .._._.........1... ---... This Permit Expires i Year From Dote Issued Application is herebymade to the San Joaquin Local Health District for a permit to construct and install the work herein { F, described.This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION .--.� _,----- -Y�. Qu��Ea� ��- - --------.......CENSUS TRACT ----------.. Owner's Name ------ --------- ------ --- -------- __.......... -- �..�-- ------- Phone Address ._ s7?4 �� .. ....Ci --------------------------------........ Contractor's Name.. --i /I4rr C��.-- ---- 1...License# --r .T�Phone ........................ Installation will serve: Residence Apartment House C�ommercial OTrailer Court ;© Motel©Other 1---- GGG Number of living units;_, . Number of bedrooms .._--_-Garbage Grinder .......... Lot Size ............... Water Supply: Public System and name ---------------------- --------------------_-_ ........Private�- Character of soil to a depth of 3 feet: Sand t] Silt❑ Clay [] Peat❑ Sandy Loam C] Clay Loam ©� Hardpan❑ Adobe ❑ Fill Material If yes,type............................ L (Plot plan, showing size of ]at, location of system in relation to wefts, buildings, etc. must be placed on reverse side.) NEW INSTALLATION: (No septic tank or seeps a pit permitted if public sewer is available within 200 feet,) SEPTIC TANK \ PACKAGE TREATMENT +) 3 [] [ SizeA. ----... -..9----.tY... ----- Liquid Depth 6\ Capacity '4 _Vst. Type . w..... Material-It.B. -�C8.... No. Compartments ..-�---.---,.... 0 istance to neWell ..--------- °------ 1D_r �[ \ � ---....---.Foundation ..-------- ------- Prop. Line-------- �------- LEACHING LINE [7 No. of Lines __.__..../-------------- Length of each line.-.__. �------.------ Total Length �,.I._---------- 'D' Box _ ..... Type Filter Material ------%._Depth Filter Material __.-......yl._ ..................- r- 5 Distance to nearest: Well ........SD.i__------ Foundation ----------1-9+a...._.-_ Property Line .........+..........:.... SEEPAGE PIT [ ] Depth -------------------- Diameter ...............- Number --- Rock Filled Yes ❑ No r Table Depth ------------------------------------------------Rock Size-------------------------- Dista Wale nce to nearest:Well -----------------------------------.--.Foundation -.--------------.-- Prop. Line .............,-------- RE PAIR/ADDITION -------REPAIR/ADDITION(Prev.Sanitation Permit#.----------------------------.---_---------- Date . ----------------- Septic ._...---------Septic Tank (Specify Requirements) -- .............. ------------------------------ ----------------------- - ' Disposal Field (Specify Requirements) ------------------------------------------_----------........--------------- ----------------------------.._-------------- F --------------------------- ----------- ------ ------------------- -------------------- -------------------------------------- ------ ------------------- L- ................. ------------.......................-------- .------------- ------------------------------ ---------------------L---------................ (Draw existing and required addition on reverse side) t rte` 1 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- I sed agents signature certifies the following: "I certify that in the performance of the work for which this permit is issued, 1 shall not employ any person in such manner as to become subject to Workman's Compensation laws of California." Signed.................................... - - Owner - By -....._.__.. - - Ji other than owner) FOR .DEPARTMENT 115E ONLY i APPLICATION ACCEPTED BY BUILDING PERMIT ISSUED--------------- ---DATE ----------------------- -- - ADDITIONAL COMMEN75 ------------------------------------------- -.........................._ -------........ Final Inspection by: ----... ----- ...... ---- ------------------- -------------- --- ...........---_... - .- .... ---------- ......_.Date € SAN JOAQUIN LOCAL HEALTH DISTRICT E. H.9 1-'68 Rev.5M F