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FOR OFFICE USE: , _ APPLICATION FOR SANITATION PERMIT (Complete in Triplicate) Permit No. ------ -- ------------------- -------------------------- This Permit Expires 1 Year From Date Issued Date Issued ___I_"_!_S;-_7 v 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 Q JOB ADDRESS/LOCATION .---jQ_�7_�------- :---------HAB7 -------4Al------ ----- -------CENSUS TRACT -------- Owner's Name ---------------1 Q,5- --------- }_ --------- ---------------------------------Phone Address '- / -------------H-191-1 !____----------- -----------.. City ---- ry'I�- _ _C� ' �w� : ------.License # --------- ----- ------Phone ---------------- Installation will serve: Residence A a Contractor s Name ______ ___________ _ t � ,� p rtment House❑ Commercial :❑Trailer Court 1❑ l �'� r� Motel ❑Other ----------------'-i Number of living units:.--'f Number of bedrooms _�-_----Garbage Grinder Nc� Lot Size _/ C_RF_a6-�_._....... Water Supply: Public System and name _______-__ ___Private �- Character of soil to a depth of 3 feet: Sand'❑ Sift❑ Clay. ❑ Peat❑ Sandy LoamA �cfay Loam ❑ Hardpan ❑ Adobe-❑ Fill Materia__/VrD__ If yes, type ____________________________ (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 seeps pit permitted if public sewer is available within 200 feet,) J PACKAGE TREATMENT [ ] SEPTIC TANK ;' Size- Liquid Liquid Depth ----- W Capacity - ZQ __-__ Type Z,�/3t F.4-B Material_ R No. Compartments ___________ Distance to nearest: Well -_--�- � __________Foundation ....fd__7t7__ Prop. Line ___,9-------------- LEACHING LINE No. of Lines _ ___r - r - -- --- . ___-- Length of>each line------ ---- --------- Total Length ___-,q/0_...... _S_ Type;Filfer Material �_ � __Depth, Filter Material ________I_.�-.__ _ U Box ir,_. ` ! f r �._ �� Distance to n ares�Well -__ rte______ �f- E_ Foundation __ ��__' "-:_ Property Line -------------------- SEEPAGE ____________ �__ SEEPAGE PIT [ ] De 01V ---------- Diameter ___________'}__ Number ____________________________ Rock Filled-A ,Yes ❑ No i❑ Water/Table Depth ' '= -------Rock Size ---------------------- Distance ------------------•-Distance to nearest: Well -----------------------i'---------------Foundation -------------f----- Prop. Line --------------- ...... REPAIR/ADDITION(Prev. Sanitation Permit r# --------------------------------------- --- Date ----------.----------------------_) A Septic Tank {Specify Requirements] _____________J 3__:._________-_--________a:_ _______-_ i --------------------------I----------------________..__. -_____________.... Disposal Field.:(Specify Requirements) __, XI STI/✓ _--_--,pll/�LL(�1/C___ _ 70 -/1l 377T � ---Q lot - �/r Dlv c l V ------- - 7Z-)---------Bi aw an stinexir - ----------------1-(,6r- exg and required'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 foil owing.' "I certify thatin the performance of the work for.which this permit is issued;,l shall not employ any person in such manner bs to become F.sub•ect to Wrk non's Co pensa Signed tion laws of California." _/J_.� -9 ................. ........................... Owner By ---------------------------------------------------------------------------------------------------- -- -Title -------- --------- ----------------------------------- ---------------- (If other than owner( - ��x r FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ---- � `--------------- -----------4r DATE --._ 'f. � ------ BUILDINGPERMIT ISSUED ---------------------------------------------------------- ------------------ '-----------------------DATE ------------------------------------------- ADDITIONAL COMMENTS --- ------ ---------------- -------------- ----- -- ------------=- ------------------------ - ----------4......e ----- --- -- -- D -- ---- ---- Finallnspecate tio _ ' a _ -' - SAN JOAQUIN- LOCAL HEALTH -DISTRICT E. H. 9 1-'68 Rev. 5M