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FOR OFFICE USE: � a E = APPLICATION FOR SANITATION PERMIT ---------------- - ------------------------ -- (Complete in Triplicate) Permit No. ---------------------------------------- Date Issued _.��--.- ------ a --------------- ` This Permit Expires 1 Year From Date Issued i Application is hereby made to the San Joaquin iLocal Health District for a permit to construct and install the work herein described. This application is made in complia�i'e with County Ordinance No. 5.49 and existing Rules and Regulations: 1 73©C7 5- --- #��-7------------IZ�-110-R CENSUS TRACT JOB ADbiRE55/LOCATION .____ -___.....__ Owner's Name -- ......... - -------------------------- -------------------------------------Phone ----------------------•----•-------- Address --- _. _ .: 0 -------� = f{ N- city -�! lLQ /`� \ c. Contractor's Name --1 .-_- �/ /3 b- f T+r ..< R�_1C',� cense # ----'------------------- Phone Installation wills ve: Residence ]artment House❑ Commercial,;❑TraiW-Court ] = Motel ❑Other -------------------------------------------- k1 Number of living units:-_ ...-? Number of bedrooms -3------Garbage GrinderVIE_ _ Lot Size -i�� 6----•------ Water Supply: Public System\acid name --------------t Private Character-of-soil-to-a depth-of'3 feet: Sand-❑.1 .Silt �;. Clay-[]s-Peat y ,s Sandy Loam Clay Loam ❑ -:;,, Hardpan E]' Adobe ❑ Fill Material A/_�`_ 1f yes,type (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) �j NEW INSTALLATION: (No septic tank\or seeps it permitted if public sewer is available within 200 feet,) y W PACKAGE TREATMENT [ ] SEPTIC TANICj!'- N Size,�' 5'_�-5 **X_5--.--- Liquid Depth _- - -------------- \J y�------------ Typefkw�DMateria! 06(C_KJ__ -No. Compartments -------�-s........ —�) Ca dcit -- istance to nearest: Well ___`_`,-�-------------- �" Foudation _:., _' ` Prop. Line _____ � '- LEACHING LINE [ No. of Lines _. i L ngth of each line--/,------7,9-- ------ Total Length __-r�+s_©._.�.-....-- 'D' Boxy-- __.. Type Filter Fate tial . . -_.Depth Filter Material -.----- --/-------------------•-•--�---- �� I fes.----- Property Line ----- Distance to nearest: Well --- _-_,`�`__ Faundati.on-__ _ ----•----•---•- �N SEEPAGE PIT [ ] Depth ____.- Diameter :_.__.__. Number -::----- Rack Filled Yes ❑. No Water Table Depth ----------------------------A` ------[Rock Size ------------------------- Distance to,nearest: Well -------------------------'------- )Foundation -------------------- Prop. Line ----.."_-----_------ 4 REPAIR/ADDITION(Prev. Sanitation Permit# --_------------------------------------- -- Date -_-------------------_---------•--) Septic Tank (Specify Requirements) ------------'-----------------------------------------------=-----------------{{--- - -------------------------,--------------------------- Disposal Field (Specify Requirements) ------_ . . v----------- -- t ------------ -------------------------------------- ----------------------------------------------------------- -------- - ) --------------------------------- -- ..�.....��we..:... � - -•'"�'ir"+.�-+,+r"�" ..... . .............. .` -..-..__-----.........----.._.-...,------.-------._,...__------------_ ------ ------ - -- ------------------------- (Draw existing 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 an'd-Regulations-of-the San Joaquin-L•ocat-iHeaith District. Home owner or licen- sed agents signature certifies the following: T "I certify in rformance of the work for which this permit is issued, I shall not employ any person in such manner as to bec o orkman's nsation laws of California." HSigned , � ------------------------------------------------ Owner BY ---•------------------------------------------------------- tRAQ---- Title --- ---- ------------------------------------------------------------- (If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY -------- ----[. -ACO-1--------------------- - --------------------- ------------------ DATE = �.�.'.. f BUILD]NG4ERM-I-TISSUED--- ------_ M. __. _ ___ ___� _---------------.DATE=___. - ..--- __. --••-- S ADDITIONAL COMMENTS --------------------------------- -------- ------ - - - ------ ---------------------- :.� A j ______ - ------------------------------------ ------7Z- _ ___ - - _____ --- _. _ .._...------..._. i� 1 i - -- -------- -- - ------------- .._. ._ _ __ Final Inspection by --------------------------- -Date .- . 1 SAN JOAQUIN LOCAL tlHEALTH DISTRICT E. H. 9 1-'68 Rev, 5M <�