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FOR OFFICIUSE: 3a U TION FOR SANITATION PERMIT Permit No. =. - �} {Complete in,.Triplicate) ----- --------------------- ------ '.` x R • :k � Yr ;: Date Issued .��as- _-- This Permit Expires 1 Yeao'From Date Issued 4. --- -------------- - - ------------------------------- Application -- -------------- �. 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: l JOB ADDRESS/LOCATION __.� --a-------- ----------------CENSUS TRACT ------------ - ----------- f Owner's Napme .tfGih rppO _' = ------:----------Phone - 3 Address Y_t 1 --------- --------------------- ---------------- City ----------------- ---- Contractors Name rP License # - Q 3 b--- Phone Installation will serve: Residence X Apartment House-0 Commercial :❑Trailer Court ;❑ i Motel ❑Other ---'---- ------------------------------ Number of living units_____ ______ Number of bedroomsy p� F 3_---____Garbage- Grinder 4-1.16.---- Lot Size ._ d-/--`----��_ ------------- __ l ' Water Supply: Public System and name ------�----- -r_ Private F]t Character of soil to a-depth of 3 feet: Sand'❑ Silt❑ . Clay [ J Peat❑ , Sandy Lo am ❑ Clay Loam ❑ Hardpan ❑ Adobe Fill Material -------------If yes,type ----------------------------- (Plot plan, showing size of lot, location of system in relation to wells, buildings,'etc. must be placed. on reverse side.) p seepage pit permitted if public sewer is available within 20.0 feet,) NEW INSTALLATION- (No septic-tank or _ PACKAGE TREATMENT [ ] SEPTIC TANK'{ ] Size---------- L __�- -v----f c?_V0777 iquid Depth _-___7_-. -----,---•- Capacity __ _ Type Pr-ti- bra h Material_4� :: No. Compartments --- ._----•--- -:-- Distance to nearest: Well --------- ------Foundation __4 -------- Prop. Line -.----------- LEACHING LINE [ ] No. of Lines ----1------------------ Length of each line-.-------4- 0---------- Total length .------------ 'D' Box 4,-`�_- Type Filter Material ______ 4-Depth Filter Material -----k-? —.. Distance to nearest: Well --- ---------- -- Foundation ---- -.----_:-- Property Line --- r Number Rock Filled Yes No i❑ SEEPAGE PIT [ ] Depth ---a._.�------- Diameter �__ -----_ -----�--- - t;- 4 Water Table Depth -------------------- - -------Rock Size -----2:7r�-- --------- ------------------ - _______-..Foundation ---° Pro Line ____�.a . Distance to nearest: Well ----------- -_---------- •------------ REPAIR/ADDITION(Prev. Sanitation Permit# .....2-6--t!� 777 ----- Date --- Septic _Septic Tank (Specify Requirements) --------------- --------------------------------------------------------- ------------------------------------ ----------g------ Disposal Field (Specify Requirements){ ...... '�" l r - . .`--__ �S - T- ----7'4------ +��-P -- -------- ------------------------------- ---------------- ------------------ ---------------------------------------- ------------- (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 l 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- "I certify that in the.performance of the work for which this permit is issued, I shall not employ any posen in such maw as to beta ubfe to Work ma 's Compensation #aws of California." Signed ------- ------------------------ ---------------------------------------------------------------- Owner By ---------- ---------------- - ---------------------------- Title --------- ------------------- -------------------- ------------------- (If other than owner) �FGREPkRTf4NUNAY --- --- -APPLICATION ACCEPTED BY - ------------------ ---- ---✓. - ---• i f' s �< "[ DATE_ --------------------------------BUILDING PERMIT ISSUED -------------------------------- DATE ADDITIONAL COMMENTS --•----- --- ----- -- � _ - - -- ---- -- - -- -- _ - ---- ------- ----- ----------- ------------ ---------- -------------------------------------------------------- Final Inspection by: - ------- ------ -----------------------------------------------•-------- - ----- Date = /� " A SAN JOAQUIN LOCAL HEALTH DISTRICT Y " 'E. H. 9 1-'68 Rev. 5M.