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FOR OFFICE USE: ^*4PPLICATION FOR SANITATION PF--IIT w --------------- --------------------------------- Permit No. - '.... (Complete in Triplicate) ----------------------------------------_--------------- This Permit Expires 1 Year From Date Issued Date Issued _ -Z...72. 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/LOC TION . I�I ems- I - -----------------------------------CENSUS TRACT 5--q---------•------- Owner's Name .._-_-- -- e-' _ -._ +�--_ _` _-_�Q-�r_F_�"" .. hone ------ -- e v Address ------ ------—------ - = City ---- Contractor's Name r?z.� ---eppartment License # 14A� Phane ... Installation will serve: Residence House Commercial ❑Trailer Court i❑ p Motel F-1Other -------------------------------------------- V1 Number of living units:.___1____._ 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 EJ Clay ❑ Peat E] Sandy Loam wlay 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 see ge pit permitted if public sewer is available within 200 feet,) r�,rt 9♦X.5° � � PACKAGE TREATMENT [ ] SEPTIC TANK [7R Size_q/;2'X-11' C_S"'___________________ Liquid Depth _______Y................ a Capacity A sa--__-___ Type __�-�+-�. _ Material__.-C�i �_ No. Compartments4SA_•;- Distance to nearest: Well _.____5.e______________________Foundation-___!_F___--_________ Prop. Line ------Iv'-`_________ LEACHING LINE [+� No. of Lines -------_3--------- g g - - - Len Length of each line- D_____________ Total Length 1`1_71- `1- --�-------••-.-- i 'D' Box ._._ Type Filter Material .......S_T� -----Depth Filter Material ---------/I-------------------------....... Distance t nearest: Well __._._54� ______ Foundation---------f.-O------------ Property Line- -----S................ SEEPAGE PIT [ ] Depth ----------- -----.__ Diameter ________________ Number ---------------------------- Rock Filled Yes ❑ No i❑ Water Table Depth -----------------------------------------------Rock Size------------------------ -------- Distance to nearest: Well ----------------------------------------Foundation -------------------- Prop. Line ------- .............. i REPAIR/ADDITION(Prev. Sanitation Permit# ____________________________________________ Date ----------------------------------I Septic Tank [Specify Requirements) ---- - ----------------------------•<-------------------------- I Disposal Field (Specify Requirements) ---------------------- - -------------------------------------- 1 -------------------------------------------------------------------------------------------------------------------------------------------------------------- -- ----------------=-------------••--------- r ---------------------------------- ........ ------------------------------------------------------------------------- ---------------------•----------------------------------- {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 E County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Horne 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 such manner as to become subject to Workman's Compensation laws of California." Signed ......... ............. ---------- - ---- Owner { BY ----------------------- ---------- �C_.--_l J Title ----------------------------------- (If other than owner) If I AOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ..f� . _ . . . ------------------------------------------------------------- DATE S``"/ .:. •--------------- BUILDING PERMIT ISSUED ----------- --- - - - -------- ---------•- - -----------------------DATE ------------------------------------- I ADDITIONAL COMMENTS ----------------- -- ----------------------------------------------------------------------------------------- ------------------------------------ ------ e --------------- ------ Final Inspection b - =- - -------------- -•-------------•--------• -------__....-••______-••--------Date , '. h SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M