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FOR OFFICE USE: ,.�LICATION FOR SANITATION PERM' . _.- .------- - - - - - .... ----- 1,/ Permit No. ._'f.?-915. - ................. - ------------- _. -- - - (Complete in Triplicate) Date Issued This Permit Expires 1 Year From Date Issued 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 m /e, ' mpliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION _- v---Q.-"-----`1---�� - " `.. - - - --- -CENSUS TRACT // .s--O ------ Owner's Name fN - . "......--........---Phone Address .. - R Q� 6ct � c� �K ° ..... City 'GcY� ...... ------------------------------------- �^.. �a.------------ -------- Contractor's Name ---c�.U.� `----- ------.License # -------------------- Phone --------- - - - ----'-'-------'---- Installation will serve: Residence partment House❑ Commercial ❑Trailer Court ,❑ Motel ❑Other __..----------------------------------- Number of living units:-------!.. Number of bedrooms -.-Z—_-Garbage Grinder ---------- - Lot Size ...............Prie --- Water Supply: Public System and name --------_--.-..----- ------------------------- ...-------.----- ---'----'"'-'"" - ivat Character of soil to a depth of 3 feet: Sand Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay 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 seepage it permitted if public sewer is available within 200 feet,) e 0 PACKAGE TREATMENT [ ] SEPTIC TANK [ Size-------------------------------------- ----- Liquid Depth ------��1--------- '14) n�,��Q��"- .. Material C No. Compartments .----�_•----- Capacity -J 190---,-- TYPe0(Ue,~ -- Di ce to nearest: Well .... ---------- ---------Foundation --�-- -------- Prop. Line/4 -------- i Length of each line ---7v---..-.---..- Total Length LEACHING LINE [ No. of Lines ----..- ------------ V - --------- 9 'D' Box �iGa..-_- TYPe Filter MatericIA4.4 dDepth Filter Material .-.-----/�...-------_�----_--- 01--._--.- Foundation ...162 roperty Line ------•--- P -- ------- Distance to nearest: Well ..CS�.1-- -------`- SEEPAGE PIT [ ) Depth ---- ------------ Diameter -------------- - Number ..-_----- _.__--------- Rock Filled Yes ❑ No - Water Table Depth ------------------------------------Rock Size Distance to nearest: Well --- -----------_-Foundation ---------------_-.- Prop. Line .....----------.---- - REPAIR/ADDITION(Prey. Sanitation Permit# . --_-.._.._----.--.-- ------ Date ..--------..--------------------) Septic Tank (Specify Requirements) ---- - \ Disposal Field (Specify Requirements) .. ... ---------------------- ------------------- -- - - - ---------- ------------------------ --------------------- - (Draw existing and required addition on reverse s d e 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, I shall not employ any person in such manner as to become subject to Workman's Compensation laws of California." Signed - - - Owner ....---------------------------------------- Title ------------._. -- -- _ .. (If other than owner) FOR DEPARTMENT USE ONLY DATE ---- APPLICATION ACCEPTED BY ----- - --- ------------ - -------- - - .....-Z BUILDING PERMIT ISSUED .----- ------------ -------------------------- -------- - -----------------DATE ADDITIONAL COMMENTS ..--.z'-'----.7------�5 4K-/z---!U `fix«-------------- ------------------------------------------------------------- ------------------------------------- /yh._ Date ...J.- - Final Inspection b �,�,....:.-ccr--------------------------------------------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT r 6 E. H. 9 1-'68 Rev. 5M