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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT -- -- I1 (Complete in Triplicate) Permit No: ..7----�_. --- This Permit Expires 1 Year From Date Issued Date Issued Applicati6—nis made to the San Joaquin Local Health District for a permit to construct and install the work herein describe Mkis a �ication is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LO X1TlON ------------ -C- �y-------.5_ ._J _ry. - C•cic - --CENSUS TRACT -------------- ----------- Owner's /' --------- Owner`s Name --{:ter-�-------- X`d f a.� / - Phone Address5---- -yM-`'------------- ------ ----------- ---------/-------------------- City ------------------ --------- ------------------ ------ ------•-------•------ IIF Contractor's Name I� s c- L ----- ------------------------------License # -------- :------ ------- Phone ------------------------- Installation will serve: �' Residence ❑ Apart AV House,❑ Commercial ❑Trailer Court's Motei Otherr'.-----DICE1 ^�'--�� '`-------- � Number of living nits:.r---------- Number of bedroom Garbage Grinder Lot Size ---_T_G1f.'.'_"'-__.______-__.._______ Water Supply: Public-5yV"tem-and. anne ---- �/--------------------------------- ---------------------------------------------------------------Private Character of soil tja depth of 3feet: Sand-I Silt El Clay E] Peat E] Sandy Loam P< Clay Loam 'E] ❑ dobe E] Fill Material ------------ If yes,type Hardpan A (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) i NEW INSTALLATIJN: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) r PACKAGE 7R i i 1. TREAT Ca aSEPTIC TANK Size.---------Y_1C--- --' ------------------ Liquid Depth -----3.-.x------------- f . p y. Ty� e _ Af.r&4 Material---------------------- No. Compartments ---2----------- 0 ------ - - We I ---.-+ U Foundation -- - --------- Prop. Line ---- LEACHING LINE: of lines ------Y_G_�.__________-_ Distance to nearest: , --- Length of each line_ ff 0 Total Length #, Box I 7,yp ilter Material ----S_1Y JO p ................................. ..r � -- a th Filter Material --------�`1-----------------•------•----•- � Distance to,! W ll ___.__y__ _____ Foundation `� -�S� Property Line ��-----.._--• 4 II X 6 X /0 � —Rock-Filled Yes R No '❑ t SEEPAGE PIT (')Q II7e`�tli _.____..1._a-�_-- r _ Nurrrber� -_�r-.------- - 1 S vim- I Water Table Depth -------- ------Rock Size s-C' rl_i s a�_�� %A _____-Foundation _ /O.d.____._ Prop. Line ._ lea Distance jto nearest: W ----- _4_s ____ __ _____--__ } f REPAIR/ADpITION(Prev. pnitati-n`Permit# _._____ k _ __'_ Date _______________________________-) Septic Tank (Specify R(quirements) ` ---------------------.----------------------------- .� ----------- Disposal Field Specify Requirements) --------------------------- ;r .: ------------------------------------ --------- - ------------------------------------------ ---------------------------- ----------------------- ------------------------------------------------------------------------------------------------------------------------------- -------------------- N (Draw existing and required addition or► reverse I hereby certify that I h1ve prepared this application and that the work will be done to accordance with San Joaquin County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Dome owner or licen- sed agents signature certifies the following: "I certify that in tke performance of the work for whiclihis permit is issued, I shall not employ any person in such manner ect to Work Vs Compensation lawsaof California." Signed -----?c'---- ---- Y as to become su g ------- ---- Owner By ------- - --------------- ------ I1----------- I---------------------------------- ---------------- -Title ---- ------------------------------------------------------------------- (!f other than owner) FOR-DEP RTM>:NT-USE`O_NLX�„ APPLICATION ACCEPTEDI � BY ------ ----- , = - ` DATE BUILDING PERMIT ISSUED . ----- - DATE .. - --------- -- - ------- ADDITIONALCOMMENTS -------------------------------------- -V--- "` w ' i. ------------------------------------------------------------- ------------------------ I ' __/_ -------------- = -------- _. - Final Inspection by: �l • ry"`' Date . S N JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 51 :II