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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT .k P3 O j �- �' r Permit No. 1 --------------------------- �10 1 Womp p a in Triplicate} t ;�) y Date Issued �[ This Permit Expires 1 Year From Date issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This a plication is made in compliance with-County Ordinance No. 549 and existing Rules and Regulations. ZV7 JOS ADDRESS LOCATION .--- �,L,- Z ,.- _�_' _ -� _y'__`- --U_�`5--- /VC- ` ._ ENSUS TRACT -- ----------------------- Owner's Name ----- j --------W I �AJ... ----------------- -- Phone ------------------ ._.. Cit �r� ��-------------------------------------- Contractor's Name ---- ---- - --- )� --------- -------------------------------License #'�2 J 32'r -- Phone Y4.J_�---Z�_/f'_ Installation will serve: Residence [Apartment House[D Commercial : Trailer Court ;❑ Motel ❑ Other ---------------------- - ------ -- - = f Number of living units:-.----_�_ Number of . edrooms ___ ___ __Garbage Grinder' -_._____ Lot Size VX'zn ---_P -------•-------- Wat , -Supply: Public System and name -_-__ ----•----------- ------------------ Private E] Character of soil to a depth of 3 feet: Sand'❑ Si ❑ Clay Peat E] Sandy Loam [] Clay LoamE] 1 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.) i NEW INSTALLATION: INo septic tank or seepage pit permitted if public sewer is available within 240 feet,) PACKAGE TREATMENT SEPTIC-TANKW ize--- ------------ ----- Liquid Depth ------ 21 - : - Type A� Material — --------- No. Compartments --�._--_Ca ----------_-- Capacity --- Distancenearest,.--W --- � to wrest:--Well. = l j Prop. Line ^^^^�� - - -� Foundation == LEACHING LINE [ No. Lines ---s7�-------------- Length of each line:-,a-> ' ------ Total Length ,___ �a_____..__-___-- �, . r ---------------------•----- YD' Box rnea .__ Type Filter Material �_i '-----Depth Filter Material -- - Distancerest:, Well___-`' ^----------Foundation ----------- Property Line -_ ...... ....... _ ... Rock Filled Yes [� No i❑ Table. Re th -----Lmber �-------------= �� -_-� Diameter � _ ---_-_-- � _ SEEPAGE PIT � Depth �-_ - - - Nu Wa#er P Z_P -- Rock Size ---- _/2_ --------- Water to nearest:-Well ---_____�-___ ___'Foundation - __�-_______ Prop. Line -.. ------.-.------- REPAIRJADDITION(Pre V.-Stinitation Permit# -------------------------------------------- Date------------------------'-----------I Septic Tank (Specify Requirements) ------------------------------- -- ------------------.-------------•--------------- Disposal Field (Specify Requirements) ---------- ------------------------------------------------------------------------------------------ -------------- --------- ------------------------------------------------------------- ---- -------------- --------------------------------------------------- -------------------- ---------- -------------------------------------------- -------------------------------------------------------- jDraw existing and required addition on reverse side) " I--hereby certify that 1 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: "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 ---------- `- _ ` r- ---------- Owner i ---- BY ---------------------- Title `t (If othe ow er) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY DATE -�d�-` --------------- BUILDING PERMIT ISSUED _ -_._ } DAT ----- ---------------------------------- ADDITIONALCOMMENTS ----'------------------ - --------- ------------------------------------------- _- - - - -- = -- ----- -`-------- -- ------- ----------=- -------------------i - --------------------------------- �1� 1�- - Fina! Inspection by: ----------------------------- ------ Date - ---------------------------- ------- I SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M