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FOR OFFICE USE: APPLICATION FOR SANITATION M-a*p - ---- - - (Complete in Triplicate) Permit No. _._------. --- ______.--.._..._--_-_.__...._-_-___ --- This Permit Expires 1 Year From Date Issued 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 /made in compliancewith County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION I-7- �-- - - -.d-----_-----.4C------ --- vyOb -_________CENSUS TRACT ._.--------_--_._.__.-- Owner's Name -�- - - -- /i/5 31'Lv�--------- ---------------- - ----- ------------ ---------- Phone Address _.-, _� Q--- - /-fid _ City ------------------------ ��rr� � ..-- // -------------------------•- ---------------------------- ---------NameJ/-A<C"-S�f --�r --------------------License # ---_.---------------- Phone Z. 'Q.. -7-,---- Installation will serve: Residence Apartment House-F] Commercial ❑Trailer Court ;❑ Motel ❑Other -------------------------------------------- Number of living units:_ ------. Number of bedrooms -_3-------Garbage Grinder _-_ Lot Size . �.-�--....._.__.__...---- Water Supply: Public System and name ------------------------.----------- ---------. . .---------- -------------------Private Character of soil to a depth of 3 feet: Sand I-] Silt❑ Clay p Peat p Sandy Loam J1r 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 pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANKj Sizej'>+ `�..t_��y}_ Liquid Depth -------------------------- -------- Capacity li�W Typerwn�/Afg aL.L7-17'e--Z-_ No. Compartments .3'................ Distance to nearest: Well _r D'--_____.-..____.._..Foundation -- - ------_----- Prop. Line - .i___ LEACHING LINE [ ] No. of Lines _- _ ---------- Length of each line-.._.1t1 G------- ____ Total Length .1". ................ 'D' Box W4"-C_4pe Filter Material/2`LF-----------Depth Filter Material ---11---.-------................ Distance to nearest: Well ----- ------------------ Foundation __ --- -------------- Property Line ........................ SEEPAGE PIT [ ] Depth -------------------- Diameter ------ -- .-_ Number ----------------- -- -_- Rock Filled Yes ❑ No Q ,�. Water Table Depth ----------------------------Rock Size Distance to nearest: Well -----_------------. ._Foundation •.__ Prop. Line -------_-------- REPAIR/ADDITION(Prev. ._._._.___.___REPAIR/ADDITIONIPrev. Sanitation Permit# -------------------------------------------- Date ------------..---------.----------I Septic Tank (Specify Requirements) --------- ------- -------------...--------_----------------------------------------------------------- .----- Disposal Field (Specify Requirements) --------------------------------------------------------------------------------------------------------------------------------------------------------- -----__------ .................- (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, I shall not employ any person in such manner as to be7e ublect t Workman's Compe t' laws of California." Signed _ V _ - ----------- - - d - j _ --------------- Owner rTitle �By ------- ------- -- 7 FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY --- -------------------------- ---- - ---- - --------- DATE -------------------- BUILDING PERMIT ISSUED -_--- --------- -- _ ------------ -----�------------ s�'� ADDITIONAL COMMENTS lLcc�+ A ._-.-- - - q / - /" Final Inspection by: -- _ l -- - -- - - ------ -- -- - -- ------- - -------------------------------------------- --------...Dat ------ ---- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H- 9 7-'68 Rev. 5M