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FOR OFFICE USE: y 4PPLICATION FOR SANITATION PERT 4 (Complete in Triplicate) Permit No: _� __ ____ i _________________________________ This Permit Expires 1 Year From Date Issued Date issued ___7=�-- _ _. Application is hereby made to the San Joaquin Local Health District for a per 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 ._ f __,.,llj/./_____I�2t �/Jf�.__ .... -------CENSUS TRACT __ __ _ ___________ Owner's Name E'd�f ......... --------------------------- --- -- --------------Phone ----- - Address --_/_ X12---/ -` 1Z_ / !•fes --- City -�c,/�ClL�. --t............................... Contractor's Name ___-License # x'¢1._73_ Phone Installation will serve: ResidenceApartment House,❑ Commercial ❑Trailer Court ;❑ Motel ❑Other ------------------------------------------ Number of living units:--- _----- Number of bedrooms 3------Garbage Grinder ____________ Lot Size ___��,___/��.��s_-�_____ 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 ❑ 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 TANK'[ ] Size------------------------------------------------ Liquid .Depth -------- ........... S7r/-�-Vr7 Capacity -------------------- Type •------------------- Material---------------------- No. Compartments •----------------_---- J Distance to nearest: Well ------------------------------------Foundation --------------------- Prop. Line ------------.:.._..... s LEACHING LINE { ] No. of Lines ________________________ Length of each line---------------------------- Total Length ,_______.___•___.___.--------- 'D' Box ------------ Type Filter Material .............. Depth Filter Material -------------------- Distance to nearest: Well _______________________ Foundation _____________________ Property Line. ______.__. .............z SEEPAGE PIT [ ] Depth -_ zv2-T ____ Diameter _4Z ---- Number _______ Rock Filled Yes No ❑ Water Table Depth ----- Q ------------------------------Rock Size -•-• Distance to nearest: Well ----- ___00 ____-Foundationd`'C>_----__:__ Prop. Line ..__ REPAIR/ADDITION(Prev. Sanitation Permit# --•----------------------------------------- Date ----------------------------------) I Septic Tank (Specify Requirements) ---------------------------------------------------------------------------------r------------ ------ --- -r----- --- Di s al Field (Specify Require _ ------Z- �� ___ ___- ---- ----------------- --- ----------------- ----------------------- ---------------- t�- ---- ----------------------------- --------- ----- -------------------------- --------------------------------------------------------- ------- -- - - - ---- --- - (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 Son 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 become sect to Workman's ompe ati.on laws of California." Signed ---.. - + ---- ----------- - g _ _ _______ ----- Owner , BY -------------------------------- w - --------- --- ----- -- ---- Title -- (If other than o ner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY --- BUILDING PERMIT ISSUED -------------------------------------- --------- -------DATE ADDITIONAL COMMENTS --------------------------------------------------------------- - - ----------- --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- --------------------------------------------------------- ----------------------- ------ Final Inspection b -------------------------------Date x ..--- - f SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M E