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FOR OFFICE USE: _ \ �r VPLICATION FOR SANITATION PER'-•T - - ...........- T w- Permit No. ------ (Complete in Triplicate) ' __-.---------- This Permit Expires 1 Year From Date IssuednPYate Issued ..!--J•- .:..7d 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 Z�z -- -----C,;--_._. /-11�._�_ _ _------ A�._ _-CENSUS TRACT _._.._ ........ Owner's Name - -- - ---- -- - --.....---�-ecQ------ - - w------y--- - ............ --Phone �. qq - - Address - ------ 7��s----- . - (.--- . ,..�....._ • _ city . . --- -------/ -- Contractor's Name .. s ... V--�"_- --__...License # Phone Installation will serve: Residence ❑ Apartment House Commercialwrailer Court fl Motel ❑Other- ------------ ------------------- ------- 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'❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam❑ Hardpan ❑ Adobe P' 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 iffublic sewer is available within 200 feet,) Type Ca cit TI QNK Mates k /------•---- - Liquid_Depth �'- --- ..... PACKAGE TREATMENT DistanceP tlo nearest: Well .S'�_S�e__ -_.-°T 'ial_�C�'v____ No. Compartments ..._�__r......... .. .Foundation _4R_Z__ ....... Prop. Line mar r Q LEACHING LINE X No. of Lines _4Z........... .... Length of line --.9.16_-_.__.._._-.__ Total Length _F.- - --------------- �/ A r D' Box -__ _-_ Type Filter Materials.. . _Cc�Depth Filter Material .... d........_..................... r r ._...._ .. . Foundation .-------- Property Line ............. Distance to nearest: Well �... 7 LZ-R�-_ S ��yy c r i% SEEPAGE PIT ( Depth .-Cfg- ----.. Diameter _ -....... Number _-----/._.._.-...____I Rock Filled Yes No ❑ / r _t ii Water Table Depth -----(F-D------T---------------------Rock Size -- - ---i----------- Distance to nearest: Well .-� ..........................Foundation ..,5 4--------.-- Prop. Line ___S. REPAIR/ADDITION(Prev. Sanitation Permit# -------- Date ------------------------. -------I Septic Tank (Specify Requirements) ----------------------- - -- ------- -- ----------- ----- -4---------------------- -----------=--- Disposal Field (Specify Requirements) -----------------C.... .-- ---- - --- - --- --- -� --- ---------------------=------------------ ----- ----------- ------------------------------------------------....----------....---------.... ... (Draw existing and required addition on reverse side) I 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: "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 bec su jed to W kma Compensatip s of California." Signed -. _ - - - --- - ----C7=E:�f`.L.�^ Owner By ---------------------------------------------f/G� e^f + �' ' Title ---- - ------------ - -.-....... _ (If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY _-___--_. k i-.. -- .. DATE ..-.--- _' .�-�' . ................. BUILDING PERMIT ISSUED - ---- ----- - ---------- _DATE ------------------------------------------- ADDITIONALCOMMENTS ---- --------------------------------- ------------------ ----------------------..---------------------------------------------------------------------- ---------------------------------------------------------------- - --------- ------ ----_--- ------- ------------------------ ---------------------------------.. ------------------- ---------------------------------------\-------------------- --------------------------------- --------------------- ------------------------------------------------------------- ----------- - --- - --- ---- 7tV ------_------ Final Inspection by: --- .{�e-l.. ------------------------------------------ --------------------------------Date ----- -�--t- ------- -------------- I SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M