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FOR OFFICE USE; APPLICATION FOR SANITATION PERMIT w. ,". Perm it No. z _ "(Complet�in Triplicate) ----------- -------------------------------- y p � Date Issued wl_-Z-� -. -------------------------------------------------------- This Permit Expires 1 Year From 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 compliant with County Ordinance No. 549 and exis ing Rules and Regulations: JOB ADDRESS/LOCATION �I ---------- -7 •---------------CENSUS TRACT Owner's TsName e t`' - ----------------------- one ��'d ---- -- --- -P —v Address fl.S.�?Q-- S City ��----- Phone Contracto ------- ----------- License # _� Installation will serve: -V Residence ❑Apartment House^❑ Commercial ❑Trailei Courf r` Motel ❑Other ---------------------------- ------ Number of living units:_____ ______ Number of bedrooms ------------Garbage Grinder _____.______ Lot Size .___.______________________________________ Water Supply: Public System and name .-------------------------------------------------------------------------------------------------------------Private Character of soil to a idepth of 3 feet: Sand Silt❑ Clay ❑ Peat❑ Sandy Loam •❑ Clay Loom Hardpan ❑ Adobe'❑ Fill Material'_ _ -If yes,type.- plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) a +IV INSTALLATION: '•(No septic tank or seepage pit permitted if public sewer is available within 200 feet,) C ACKAGE TREATMENT >e SEPTIC TANK [ J Size------------------------------------------------ Liquid Depth -----1----____-___,.---- 'Capacity �J--- Type -------------------- MaterialFJ? `(1J:Sxo, Compartments -----C<1 -------•-•- Distance to nearest: Well -------Foundation Prop. Line _le_____________ � LEACHING LINE No. of Lines -___- ...------------ Length of each line_.-.,_,__;7.5... ....... Total Length ------ D' ____D Box - Type Filter Material ZIP44-_Depth Filter Material _-_-, ______________ --.___.______ 11 Distance to nearest: Well 1- 4-4-2-t---.--- Foundation/t6_`_M1-4----- Property Line. ___ ...------------ I ` SEEPAGE PIT J Depth Diameter ______-_-______ Number _____._____________________ Rock Filled es ❑ Io ❑ I. Water Table Depth ---------------------------------- Rock Size ---------------------------- f ------------- -----Foundation -- ----------------- p. Line -•-•------- C_ Z Distance to nearest: Well ____________________ Prop. _ • •--- � �� t '. b REPAIR/ADDITION(Prev. Sanitation Permit# ------------------------------------------ - Date -------------- -------------------I Septic Tank (Specify Requirements) -------PART------a-------OJT--------- 1----UA[I-r--- M_EN—T,!-------- ------------------ � k Disposal Field (Specify Requirements) ___ r____fNRT1:41--Q�13-R1ryY--- fF�'� O-F~ -- -----CM-013 t�-----1.40M-Er------mlmki------ -------------------- UNT1� ' 5-----J.4A-- _---- Al--- IN _TR_ �1 _AP-PRQK------- t---/A------R-6.0 r " _. r`(Draw existing--arW required •addition on reverse-side)*F -� -� — -�-• - -- -- --,+» 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 the performance of the work for which this permit is issued, 1 shall not employ any person in such manner i as to become subject to Workman's Compensation laws of California." t Signed _ ct Owner i -- , �- BY - - elf/ i F Title ----------------------- ------------ �!'L G (If other than owner] i 2/� � a FOR DEPARTMENT USE ONLY ) APPLICATION ACCEPTED BY __-tJ?�_ --------------- DATE .�--" �1 ! BUILDINGPERMIT ISSUED ------------------------------------------------------------------- ----- -------------------------------DATE`----------- ------------------------•-- ` ADDITIONAL COMMENTS --------------------------------------------------------- - --------- ----------------------------- ---------------------------°-------------------------------------- -------- -------•-- ------ ----------------- ---------------------------------- ------ ------------------- ___ -__ _- __-_ --_______----. ---------------------------------------------------_---". - _ --------- Final Insp b •Date _. p �� ------------ SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M •