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FOR OFFICE USE: 'APPLICATION FOR SANITATION PERMIT 3 0 ( � � l Permit No. -----. -- l - - � (Complete in Triplicate] -------------- .• _. Date Issued This Permit Expires 1 Year From Date Issued I 4 Application is hereby made to San Joaquin Local Health District for a permit to construct and install the gwork herein a described. This application is a e in compliance with County Ordinanc No. 549 and exist• Rules and Re ulations: .FFt4��c/ G'".. _ NSUS TRACT ? JOB ADDRESS/LOC ATI N .--- - L`'�-v'- wU`�` ---- - -------- --- R P A2- S S ----- Owner's Name . -: . . _Q1 . cit vGIi'7�1_ '-----------------------4/7 �.. . ----•- Contractor's Name __._T -��-1-5_- ----mss-- 0-I11 -----f-Nc-=-'--------License# 4-SW------ Phone A7AP7---- Installation will serve: i Reside a ❑Apartment House'❑ Commercialrailet Courts❑ rMotel ❑Other --. ---------------------------- ,*N(_ Number of bedrooms_-----------Garbage Grinder : --Lot-Size f --------------I`-r-ff-------------------- Number of living units:,*N(- -v Water Supply: Public System and name ' __ ----------------- ---Private ❑ } Character of soil to a depth of{3 feet: Sand'❑ ilt❑ Clay ❑ Peat❑ Sandy Loam 0 Clay Loam ❑ , Hardpan [jAdobe-Z Fill Material --- ------- If yes,type_-------------------------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. mu;tLbe- placed on reverse side.} NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) er SEPTIC TANK' Size- X--- X ��r ,Liquid Depth-5Z---------------- =' i PACKAGE TREATMENT [ � ; 3 e�l�Q n _. Compa�tments� - ,--...._-..- capacityhw-t Typ I! - Material �[' No. ' __,. ., r. I = :Prop._Line _.f Q--�-----i Distance ito nearest: Well ---__�Q_lti(�_____________ _Foundati on __ --- _.___} _ ..x c � LEACHING.L'INE `6Q No. of Lines --. --------- -- Length of each liJ�e__ s0V_":""-= I Total Length. ---------- 'D' Box . Type Filter Material - _--- g(---Depth Filter Material `-f- -_____-`-.---•------------- € Distance to nearest: Well . �_Q-l�E-- Fouridation __ '--------- Property Line • y (t i SEEPAGE PIT j� Depth _12.5--------- Diameter __-- _ Number -_C- ------------------- 4 ------- ---- Rock Filled Yes No l❑ m Table Depth ��- 19 9- ; -------------- Rack Size�_�kZ__-�_ -------------- Water ► n I Distance to nearest-Well ----1 ---------------Foundation.---__._��--- - -- Prop. Line .``---.----- i f Date --------- ---------- ---------) = +... REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- I __----________________________I Septic Tank (Specify Requirements) ------------- - - . ------=------ -=-------------� Dipl FieldRequirements) ��-•- --sa -- ------tsrG� y .,-_------ -----�------------- �. - - -------------------------- ' -------------------------- --`--- -------- ------ ---- ------------- ----------------------------------------------------------- (Draw existing and required addition on reverse side) I hereby certify that I haveprepared 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 [icon i 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 beco ub'ect to Workman's Compensation laws of California." ) Signed -- #� -s _ Owner Q x BY ------ -, ------- -- - �(if other than owner) ..• '" "= FOR .DEPARTMENT USE ONLY '`-APPLICATION-ACCEPTED BY't- ,_ ------ -- - - - ---------------------------------------------------------- DATE ------------------------------------------------ BUILDING PERMIT ISSUED - ---- ----- DAT yj I ADDITIONAo CO N.TS --Q--- = 'c�` - 1v�?�l�a L c .� 2rf1� ----- ��rT �� t ------------------------- ------•-------------------------- \. ---------------- ----------------------------------------------- �. - ��.l Final Inspection by: ---- Date -- _� SAN _ JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M `