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FOR OFFICE USE: &ra� � 02 0�5 — C� X APPLICATION FOR SANITATION PERMIT --- ---------------------------------------------------- Permit No. I. (Complete in Triplicate) - ---------- -----`- '-- -------------------------------`---- ---------------II---_ This Permit Expires 1 Year From Date Issued Date Issued ` .- l Z:13..7f "'1 (4,$t �s�.�,�a ,��,/� Application is h a to the San Joaquin'Local Health District for a permit to construct and install the work herein -described. Thi ationis made in compliance with County Ordinance No. 549 and xisting Rules and Regulations: JOB ADDRE / OC Ol , �1�''11 f' C �r3 ,L�l-+ _l .l__ NSUS TRACT __5 � Owner's Name '1--------J iC ----------------------------------------------------------Phone --- ----------- --------....... y y R , cityAddress --------- Contractor's Name ------- Contractor shame --`------------------=-- ___-_License # _2Phone�� -/� Installation will serve: ResidenceJ'Apartment House�❑ Commercial ❑Trailer Court l❑ Motel ❑ Other -------------------------------------------- oe Number of living units:--__ ---_ Number of bedrooms .J7----Garbage Grinder/6'5_ Lot Size advIla��-�'-------------- Water Supply: Public System and name ---------------------------------••------------------------------= ---------------------------------------PrivateA oS, Character of soil to a depthlof 3 feet: Sand'❑ Silt Clay ❑ Peat ❑ Sandy Loam -❑ Clay Loam ❑ Hardpan Adobe ❑ Fill Material ------------ if yes, type __________________--_------ 1 (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 01 PACKAGE TREATMENT { ]�° SEPTIC TANK Size_- XIX_-_0`----------------------- Liquid Depth ,--_________-___.___.- Material-exA4------_ No. Compartments a Capacity --� ---- Type - - -- - p 'l - - � _ Distance to nearest: Well ___ ______�a/________________Foundation _,�Q'___________ Prop. Line __ ____ --. - LEACHING LINE )4 No. of Lines XP--------------- Length of line--- ___ Len �� Total Length 1 __.....---- 'D'I�'Boxxi�_�``'_ Type Filter Mate riaV4__eA Depth Filter Material /�d_______________________________ Distance to nearest: Well _ _________ Foundation _9 _�_-------- Property Line -_-. SEEPAGE PIT [ Depth _r� ---------- Diameter •��r___ Number ____�--------------- Rock Filled Yes�� No i❑ 1I Water Table Depth '--_,7e------------------------------------Rock Size 1--- --------•- o Distance to nearest: Well , _________________________Foundation -/��.-� Prop. Line REPAIR/ADDITION(Prev. SaMnitation Permit# -------------------------------------------- Date __-__________-_- ----------------- Septic Tank (Specify RequIMirements) ---------------- -- -- - - ---------------------------------------------------- ---------------------- ---- ------------------- Disposal Field (Specify Requirements) ------------------------------------------------------------------------------------------------------------------------------------- - ------------------------------- ----------------------------------------------------------------------------------------------------------- -------------- ------------------------ ------------------N--- ------ ------------------------------------------------------------------- ---------------------------- --------------------------------------- - ��, (Draw existing and required addition on reverse side) 1-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 t owner) FOR DEPARTMENT USE ONLY 001, APPLICATION ACCEPTED MB ----- -- -- -----. DATE ------------------- BUILDINGPERMIT ISSUED'i ------------------------- ---------------------------------------------------------------------DATE -------- ---------------------------------- ADDITIONALCOMMENTS !(-- --- -- ---------------------------------------------------------------------------------------------------- - --------------------------------•,, li ------------------------------------------'I--------------------------------------------------------------------------------------- --------------------------------------------------------- - - ------ ---------------------------------------- Final Inspection by: -- Date 1 - '� - ------- SAN JOAQUIN LOCAL.HEALTH DISTRICT E. H. 9 1.'68 Rev. 5M. t