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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT .`V JPermit No. ----------------------------------- 4,;_-`-------------- (Complete in Triplicate) . Date Issued��'--AT-2_v. ------------------ ' x This Permit Expires I Year From Date Issued made to the San Joaquin Local Health District for a permit to construct and install the work herein Application is hereb described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: 5p.5'_.. JOB ADDRESS/LOCATION �.1d---3o �5 £ -CENSUS TR _____ -- - - Owner's Name ---------=ll/g_11/ 11 —�._PhoneCd_ _'3,7 - G� - r rY1 ?� /9 --------------•--• City /✓1 ------------------------------------------ Contractor's Name ------ �Af✓------------------- --------------------- License # So73-�0---- Phone ---------•--------- Installation will serve: Residence [?�<Partment House❑ Commercial ❑Trafiler Court [1 c Motel ❑Other ------ ------------------------------------- ` �j ---- -------- •- Number of living units:_-l-_____ Number of bedrooms ______Garbage Grinder _ _ ___ Lot Size __-____"�<-W c5 Water Supply: Public System and name _______________------__ - " Private f S Character of soil to a depth of 3 feet: Sand'�Silt❑ Clay ❑ Peat❑ Sandy Loam 0 Clay Loam 0 I Hardpan ❑ Adobe ❑ Fill Material ---__--_.___ If yes,type ____________________--___ s I (Plot plan, showing size of lot, location of system tin 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,) PACKAGE TREATMENT { ] SEPTIC TANK'[ ] Size------------------------------ Liquid Depth ----------------- Capacity -------------�- Type - ------ ------- Material----------� -'----- No. Compartments Q Distance to crest:•Well --------------Foundation ---------------------- Prop. Line --- ------------------ I --- Total Len th ----------------------_- LEACHING LINE [ ] No. of Lines __--------- -------d L ngth ofa ach line__ -- ----p-_----------- g D' Box ,---s_ -h-- Type Filter M terial - -�j---- :�-Depth- Filter Material --------------------•--------------------- - Distance to! nearest: Well ------- ----------- _-- Foundation _---:-_____--- ------ Property Line --_-_.------.---••------ SEEPAGE PIT [ ] Depth ---- -- ---- Diameter -_---------'--"--; Number --------r_":_- ------ Rock Filled Yes ❑ No i[] Water Table Depth ---------- V ---------� --------------Rock Size ----------------------• -------- Distance,- nearest: Well -- -_ ------j---- -r_ -- foundation -------------------- Prop. Line ---•-----------•- V REPAIR/ADDITION{Prev. Sanitation,PermTt# _______--___ ------- - y�-:___--Date•--------------------------------- iI, -_ _-___ Septic Tank (Specify Requirements) ------------------- -- � -----------------------•----------------------- --------------- -�r — Field (Specify Requirer entsj �' ' -- a, --------------------------------------- Disposal . x�sr -svr --------------------------------- s' --------------------------------------------- -. = ---------------- - -.--..- ---------------------------------------------------------------------- - (Draw existing and required`addition on reverse side) I hereby certify that 1 have prepariied this application and t"t the work will be done in accordance with San Joaquin County Ordinances, State Laws, aI ales and Regulations of the San Joaquin Local Health District. Home owner or licen- sed agents signature certifies the folio ing. k "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." � Owner Signed ------------ i ------- ----------------------------a-------- By (If other than oxilmrr FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY t j-Ct -------------------------------------------------------------------------- DATE _--- --. BUILDING PERMIT ISSUED ------------------------- ------------DATE -------------------- ---------------- ADDITIONAL COMMENTS --- --------------------------------=------------ -------------------------------------- ------- ------------------------ ---------- --- - --------------------------------------- ---------- -- -- --- - - -- --- ------- --- - - - - ------------------------------------------- - ---spec ' Date ------ ------------- Final `T SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M