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FOR OFFICE USE: APPLICATION FOR SANITATION PERJ '"- (Complete in Triplicate) Permit No: 261 -------------------- ------------------ This Permit Expires 1 Year Fram.Date Issued Date Issued __5`-_l -�� _ -------- Application is hereby made to the San Joaquin Local Health District for a permit to c stru an ika� t ork herein described. This application';is made in compliance with County Ordinance No. 5'49 an I and ' g lotions. JOB ADDRESS/LOCATION '�z0- ;e ------- =- ---- --__CENSUS TRACT -------------- - -- _ Owner's Name .1F7_f� 7 ---------------------•------------------ ----------------- ------------- --- Phone ----------- Addressi' -- �I City __X _ !------ -�-- --- ----------------------------- Contractor's Name .----- ,� _- f� �- e ------------------------- --------License Phone"`__��' ��--- Installation will serve: .; Residences Apartment House❑ Commercial :❑Trailee'Qourt ❑ i Motel ❑Other ---------------------------- Number of living units:._' .__ c-' ; I Number41of bedroor�ssW' Gtsrt� e"Grsticler P '---------°-........ Water fat Supply: Public Systemh and name E! I - - ---------- -------'-----------•----•--- ------------ --------------------Pry Character of soil to a depth of 3 feet: Sand Silta a. ❑ clay ❑ Peau❑ Sandy Loam Clay Loam, ; P ❑ ❑ Hard an Adobe'❑ Fill Material ----- -- If yes,type ____________________ f_ (Plot plan, showing size of 16t,, of. system in relation to)wells, buildin , etc. must be plated on reverse side.)/ Q NEW INSTALLATION: [No�saic tank r seepage pit permittedfif public sew?,,r is available within 200 feet,! rpt PACKAGE TREATMENT [ ] `'SEPTIC T _ SizeV, l ��: _ Liquid Depth'✓ � paci � __ _- Ca ` t�✓ _ ' ' Ype Material_ - -- No. Com artmehts . Dist6nce to nearest: Well _ ' X, ' 'e J -��•�'-------�----------foundation - l�------=------.Prop. tine"_`------ NE No.'!of Linsz _ --------------- Lengt4 of each ---------- Prop. Total Length r �-� --- kEACHING LI_ D' Box X -:Type Filter Mate iaJ11f,440-GtfDepth Filter Material ____________Distance to to neares WeII- Foundation _ A-40 --- ---- Property Line ------------- SEEPAGE CJt ------ } PIT De .th �_:_ D1ame er — - SEEPAGEp„ - _ Number _-- _-- Rock;Filled. . !❑ ---- - � -- oc Yes- No Wateyr Table Depth - _- / 'S' 1 r !, � --- f -Rock Sizef-_�"'.�-. . . Distance to`ne&e WeII _ Foundation f4S`� , av 6 Q Prop. Line J�-�- REPAIR/ADDITION(Prey. Sanit6'tion S mi"t# -. ,, - ; - ------ . Date -----------------�-- --...----� -?' • Septic Tank (Specif' Requirements) --------- Y' F > }' ------•--------- +, == - . w Disposal Field (S ecifY Re46irements) r------------------ ----- T ----- � _ e.,.....�..,,.._.....__.._.y.. ...._. .. ---------- ------------------ -- i (Draw existin6 and required addition on reverse side) I hereby certify that I have prepared this application and that the work will be done in qtc rdan'set 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 °'uch manner asto become subject to Workman's Compe sation Jaws of California." El 9. .d ------- - -.- •:�------- Owner BY ' ------------------ .7 -- Title g ------- - ---- - - [If r than owned ------ --�------ DEPARTMENT USE ONLY ` APPLICATION ACCEPTED BY��._ _ -___ __ _ _ _ - f ------------- - DATE U - ----------------------------------------------- BU BUILDING PERMIT ISSUED -'I --------------------' --------------------DATE ---------•------ - - -------------------- ADDITIONAL COMMENTS ----!I______________________ � -- ---- ----------------------••----------------------- _ ` - _. ___________._____-_______-_ _ _______ I r-.. .------------------------------------ --- ------------------------ : ------- nspection by; - --------- -----------Final ^ - __ SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M.