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FOR OFFICE •USES APPLICATION FOR SANITATION PERMIT ------------ ---- ----- - Permit No... 5`� (Complete in Triplicate) ---------=----------------------------------------------- -------------------------------------------------- _----- This Permit Expires 1 Year From Date Issued bate Issued 1� - -, -- 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 compliance with County Ordinance No. 549 and existing Rules and Regulations: q u "" JOB ADDRESS/LOCATION .---.�,�J-�Q-._-� {.f------ P R RQl--,�-----------�SC -----------CENSUS TRACT _'----6-----------_-- Owner's Name t-1v1-M, + ---------------------------------- ------------Phone.,9 --- _ -------------------��—.:- Address -------- --------101711----� �� M4----------------- city SGAL© '------ -= =----✓---------------- -- -- Contractor's Name .-0W_t11-�K---------------------------------------------------------------License # ---------:-------------- Phone-__:00-g�--=--------- Installation will serve: Residence 0-A-p-a—rtment House❑ Commercial ❑Trailer Court l❑ Motel ❑Other -------------------------------------------- Number of living units:......F----- Number of bedrooms _3------Garbage Grinder -N.p-... Lot Size _-&_Rv�a-=---------------- Water,Supply: Public System and name ------------------------------------------------------------------------------ ---------------------------------Private Character of soil to a depth of 3 feet: Sand'[} Silt❑ Clay ❑ Peat❑ Sandy'Loom ❑ Clay Loam Hardpon Adobe ❑ Fill Material ----- If yes, type -----------------;K", (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,) '� r PACKAGE TREATMENT [ ] SEPTIC TANK Size__ iY l'x_-_ __ `_-- Liquid Depth --- Capacity 150-0 Type t'WI- s MaterialNo. Compartments _-. Distance to nearest: Well ___-___-___-�0C------------Foundation ------- Q--------- Prop: Line --___g-,____--_-__ p LEACHING LINE [il""'No, of Lines ------7r------_- Length of each line------- Q-- r------ Total Length D' BoxType f=ilter Materia(4?0.C1<.___Depth Filter Material ----__19------------- f...- Distance to nearest: Well -__ Qf `-a------ Foundation -----AQ--`9`_------ Property Line SEEPAGE PIT [�'J' Depth -_/�--i_-----_ Diameter _ _ Number -------_ ___------_- Rock Filled Yes No 0Water Table Depth ---- --------------------------------Rock Size -I -;- --- Distance to nearest: Well ------------ ------ f :-:.::-_:Foundation _/-0__,.-'------- Prop. Line -------$--____.__._____ r REPAIR/ADDITION(Prev. Sanitation Permit# -------- ---------------------------------- Date --_-_------------_--_-_--____----_) Septic Tank (Specify Requirements) ------------------- -----------------------------^° = :------- ----- Disposal Field (Specify Requirements) ---------------------------------------------------- v - --- -=---------------------------- - -------------- -----------------------------------------------------------------------------------------`------ -------------------- --------- ------ -------------•--------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- (Draw existing and¢reguired 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 San Joaquin Local Health District. Home owner or licen- sed agents signature certifies the following: I "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 ec e.6ject to Workm n' Co f a laws of California." Signe -- - - ------------- ti -------- Owner BY ---- ------ --- -------------- ------------------------------------------------ Title _ ----------------------------- ---------------------------- -- (If other th owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY =f7--------------------- --------------------- ------- DATE _ .f --3 ' BUILDING PERMIT ISSUED - -------=---- -------==-----------==-------- - —DATE -_`----------------------- - ---- -- --------------- ------------------------------------ COMMENTS ------=-------- ---------------------------- ---------------------------------------------------- -------------------------------------------------•--- ------- ------------------------------ --------------------------------- ---- -------•--_----------------------___-__-______-______�_-----_-____-___ ._-.-------________-___--------__---_-------------_--_-__--_-_-_-__-_----_--------_____-_-- -_ ' ---------------� -- i Final Inspection by ------ -- ------- y�------- --------------------------------------- Date �ra 3 SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M