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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT - � Permit No: 7-,!-1-.0-��. _ ------ -------- --------------- --- 'i (Complete in Triplicate) t i ------------------- Date Issued 1-1_-2-Z-:V This Permit Expires 1 Year From Date Issued Application is hereby madl� to the San Joaquin Local Health District for a permit to construct and install the work herein described. This applicationl'is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRE55/LOCATION . �ILc2- -- - 4," -� ----------------------------------------- -------r---------CENSUS TRACT ------------------------ �2V--------------.Phone. 5--g9'Fe------ ' Owner's Name . .' - City - - ---------------QAddress r ense # 3--- Phone -- - �-74 s Name --------- -------Lic Contractor Installation will,serve: • Residence Er-Alpartment House❑ Commercial ❑Trailer Court ❑ w. Motel ❑ Other --- ------------------------------------ Number of living units:_.-.?-------- Number of bedrooms c -.---Garbage Grinder ------_- -- Lot Size-�x !4© I�; Private ❑ Water Supply: Public System and name ------------------------------------ Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat❑ , Sandy Loam -❑ Clay Loam ❑ Hardpan ❑ Adobe 0-Fill Material ___--'------- If yes,type _------------------------_ ,I. {Plot plan, showing size �6�f 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,} Li PACKAGE TREATMENT { ] SEPTIC TANK' Size-?,- - •--------- quid .Depth -- _--___--_.-_-- --_. C! parity �134Type Material- s No. Compartments --•---•-------- Distance to nearest: --- --------------------------- - - p' Foundation _/O-------- ----- Pro Line --�..�-_----•.--...•-- i LEACHING LINE V,< Nlo. of Lines _/------------------- Length of each line___,�a--------------- Total Length ,lQ�•-------------- R' Box rte- Type Filter Material _A,0 --Depth Filter Material -_/ J�`--------•-- r Distance to nearest: Well ------------------------ Foundation Q`-------- - Property Line. ------.--------- -.- I � . �I. �f SEEPAGE PIT � Di�pth .-2-�---------- Diameter ,.��------- Number _../--------------------- Rock Filled Yes ' No I❑ Water Table Depth ------------------------- -------Rock Size -__--a --X:� r Distance to nearest: Well __--_---------------------------------Foundation_----- _--`� Prop. Line . ---•••-•------- REPAIR/ADDITION(Prev. Sanitation Permit# --•-`----t----- ----- -------------'k.--- --- ------- Date -----------------------•----------f Septic Tank (Specify Requiiements) --------- °------------------------------------------------------------------- ,--------------- 1. Disposal Field (Specify Requirements) -:---_'_'_- -------------------------------------------------------------------- -- -------------------------------- i ----------------------- (Draw existing and required addition on reverse side) I hereby certify that 1 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 Disirict. 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 uubbjecctt to (Workman's Compensation laws of California." ` Signed _ .-. ,5.. - --- --------------------------------------- Owner/� By ---------------------------------------------I ------------ ----------------------------- Title C=� �'(If other than owner) F EPARTMENT USE ONLY 'l. - ---. DATE - ---�/- ------------- APPLICATION ACCEPTED, BYj - - --- --------------------------------------------------- - DATE ------------------------ BfUIL'D�IN-�G PZERMIT ISSUED ------- ----- ADD a >� ! •.'- -- ADDITIONALfCOMMS ----- -- ---- ---- -- --- - ---------------------------- -- --------------------------------------------------- -------------------------------------------------- �yl " rF' rf -----(--------- -- --- ------------- ------------------ ------------------------------------- r ---- -------- - O - - --- ----------- ------- ------------------------ ------- Date = Final Inspection b ---------------- - ----------- ------------- UIN�CAL HEALTH DISTRICT .; k` �" E. H. 9 1-'68 Rev.