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FOR OFFICE USE: ---_ --_fir _ 3 a-�+ APPLICATION'FOR SANITATION PERMIT ------------- (Com lete in Triplicate) Permit No:-------------- �L --------- -- ---------------------------___--_________ This Permit Expires ] Year From Date Issued Date Issued __ :__/- _:-7 2- Application Application is hereby made to,the San Joaquin Local-Heaith 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: JOB ADDRESS/LOCATION 17_a-1_ ) ---- CENSUS TRACT ---------- Owner's Name ------- - ---------- _Phone -- / ��l - -- - - -------•-- X66---a7 U"---------- Address ---- ------------------------�IP l -�� -�-� Cit ----------- Contractor's Name ----==:. _`License Phone Installation will serve: Residence [Apartment House�❑ Commercial :❑Trailer Court ;❑ Motel ❑Other . `' _ --------------------v Number of living units------ ----- Number of bedrooms _.Garbage Grinder ___ ----" Lot --- ----------------- Water t Supply: Public System and name "x y -- -------------•-------;- - --•------- --- -•------ ___,t�______Private ❑ � Character of soil to a depth of 3 feet Sand' Silt Clay -\ fl y .❑ Peat❑ Sondy.Loam ❑ 4,,Clay Loam ❑ Hardpan ❑ 'Adobe Fill Material--------------If yes;.type (Pl'ot 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`'avallable within 200 feet,). PACKAGE TREATMENT { ] SEPTIC TANK' J -- ------ , — ------------ - -- Liquid Depth __:�-- --------------- rE . Capacity_� L . _� Type _-'-- - T�--- Material__ - _ V --."-_""-- No. Compartments �--------------------- Distance ---------•----.-- 1, o`snear6st: Well ------------------------------------ '` r % Foundation ---�-_S� -1'-"- _-- Pro Line _ _ � LEACHING LINE Noi of Lin' is ante t s es°i,#--;f Length of each line ---- Total Length :--1"�?-.---•-. ` 'yp e Filter Material _ rl; ------Depth Filter Material ce Distan-ce--to-nearest,: Well ______ _____ _--.Foundation IA-2----------- Property Line �_- -------- SEEPAGE PIT De the r rr P Diameter _,4------- Number -------I------------------ Rock Filled Yes No Water Table Depth ---------------------- -------Rock Size -- ---- Distance to nearest: Well _,r_____________ ' Foundation Prop. Line ............... REPAIR/ADDITION(Prev. Sanitation Permit# -----------------------_---_----- Date Septic Tank (Specify Requirements) Wiz_=- -"------- -- --- 4 -------I-=--------------------------------------- - Disposal Field (Specify Requirements) _____ a �� _`= ---- -- - v------- ------------ 3.. ------------------------------------- ---------------------------- =- ----- :i .. '�41r wt � ------------------------------------- ram _ _ ____________A.___________-_-____ _.__.-_.-_-_ _._ raw existing and�equired addition on reverse side)' Thereby 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:' �._ 'j 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." Signed ------ } i � caner.._...._ - � 3 BY - ---_------- Title ----- (If of er than owner) R TMENTUSE ONLY APPLICATION ACCEPTED BY*---------- /1 BUILDING PERMIT ISSUED DATE --- '7""" ----------------- DATE ADDITIONAL CO S - I--------------- = --- -- ----- ` '------- 1! 'x_ ----------------------------4-------------- ---- Til- 4 ya rc a �_ __i `~a_ ° ------ ------ -------f ' Final Inspection by: - -- ---- ------------------------- ---- ------------------------------------ � / �-� -- --- ---.. _ = ---------.. --------------------------------------------- T ---Date��r-- - - - ' SAN JOAQUIN LOCACi HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M