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OFFICE USE: 000, APPLICATIM- FOR SANITATION PE T � .•.... ... Permit No. (Complete in Triplicate) -"...................... . _ 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 compliance with County Ordinance No. 549 and existing Rules and Regulations: cry JOB ADDRESS/LOCATTi N _. .....�1W.../4��-.""...-._-.-._----CENSUS TRACT .......................... Owner's Name -LJ= ?V..---•�i�......... ...............................................................Phone��,O f_WP_ 577 Address .... City ---h�� "------------------------------------------".------------------ may- P� Contractor's Name .� __ �JJ%J=' .___.�,ewl.................License #��/�4y-. - Phone Installation will serve: Residence;,Apartment House❑ Commercial ❑Trailer Court J-] Motel ❑Other ---------------------------------------•••-- Number of living units:-"-,/----_ Number of bedrooms .....Garbage Grinder ./V(7. Lot Size _/v ...._ . . --•_----•-.----- WaterSupply: Public System and name ........................................................—------------------.................................Private ❑ Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat❑ Sandy Loam 0 Clay Loam ❑ Hardpan ❑ AdobaA 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,) I PACKAGE TREATMENT [ J SEPTIC TAN Size..V'�,�'e '~...._..... Liquid Depth / --��__I............. Capacity/ ... Typ Mater ZOVV`� �No. Compartments ............:.... 1 Distance to nearest: Wel ®.......................Foundation/ .......------ Prop. Line __T _--- LEACHING LINE jj� No. of Lines - . Length of each line_... Total Length ....... .... Ar D' Box e.. Type Filter MateriaDepth Filter Material ".I�................•--...._..._......... DistanEe to nearest: Well ........................ Foundation .._......... ----------- Property Line SEEPAGE PIT ( Depth .... Diameter ....... Number .__!............... ... Rock Filled Yeses No ❑ C i,/� /i ` Water Table Depth ...1.3Dd................................Rock Size __ /X Ir- ........... r- ...._-. - - Distance to nearest: Well ..../ ----------------------Foundation to----------- Prop. Line -.-. ........ REPAIR/ADDITION(Prev. Sanitation Permit# ......................................... Date ..................................) SepticTank (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 t e performance of the work for which this permit is issued, I shall not employ any person in such manner as to/becomect to W r an' mpensation laws of California." Signe ------- ----- . -------•----....................................-- Owner By ---- -- ............. Title ----------..... _------------ ------ ------ - --------------- r an owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY _.... . ...............-....................................................... DATE _.5- >' �----•--------------- BUILDING PERMIT ISSUED ------ ----------------••-----........--------....._ .__..............---•-•............_....__DATE -•----••----------•-•---••---•----------•-- ADDITIONAL COMMENTS --___..... --•--•---••--•--•--------------••••---- ------------------------------ - ------------- Aad- -- _ . ------- ---- ----- - ---------- -- --- - ------ -- - ---- ------ ----------------- --- - Final Inspection by: ----_-- - Date _.---------- --------•-•--•--•-----•-- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M C-L