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^Ip FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT " 6� Permit No. '� -F ------ --------------------------------------- (Complete in Triplicate) ',� { €------------- -- -------------------------------------- Date Issued ---`------ This Permit Expires 1 Year From Date Issued Application is hereby madetothe 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 �, stin /R � and Reations: JOB ADDRESS/LOCATION ._�-L-10 ---- --, .- --- ' '-°" -------C el SUS TRACT ---------- J 1 _-Phone ----------------------------- ------ Owner's Name Addressi.�----` ''a City ll ------ I Contractor's Name _- -- -------- - "' 1T -g License #�C. —� p_ Phon - - li Installation will serve: Residence rKpartmenfi House❑ Commercial ❑Trailer Court ,❑ I. ' Motel ❑Other -------------------------------------------- Number .__---- - 31 ------------------------- ----- - - Private ' / -- Lot Size -- ---------------------------- ------- .. Number of living units:_-_!-____ Number of bedrooms -T-______Garbage Grinder ,� - Water Supply: Public System and name ---------------------------------------------------------------------------- -- Character of soil to a depth of 3 feet: Sand' Slit E] Clay ❑ Peat❑ Sandy Loam ❑ Cla Loam r` Hardpan F-1AdobeF1Fill Material ------------ Y________ if es, type ----- ------ ---- - (Plot 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 seepa a pit permitted ife public sewer is available within 200 feet,) SEPTIC TANK' �r PACKAGE TREATMENT [ ] [ - Liquid De th�---- - -- No. Com s �1 Capacity �x- � �TYpe`` r� Materiai-------------------- Compartments f Distance to nearest: Well ------��------------ ----- Foundation _�f�------------ Prop. Line __- LEACHING LINE [ No. of Lines _� ----------- -- Length of each line_/QQ-f----- Total Length Cil% i 'D' Box _' --- Type Filter MaterialeAKC,,4---Depth Filter Material /f_11111------- ----•- --••-- a -- a rtYLine �-- Distance.to nearest: Well 0/D-- --------- - Foundation cpC ----- ------ Pro SEEPAGE PIT [ } Depth ---------z----- Diameter Number ----- ----------------- -___ Rock Filled Yes No 0 Wgter ab ------------Rock Size ------- ------------------------ Y T1e Depth -------- -------------------- s , Distanceto nearest: Well - ---=---- ------ Datendation-------------------------------- } Prop. Line . REPAIR/ADDITION(Prev. Sanitation Septic Tank (specify Requirements) - ... .... Disposal Field (Specify Requirements) -- - ------------------------------ ----------------- ------------------------------------ A. ---- --------------------------------------------------------------------------- ---------------I-------------------------------- ------------- •------------- ______--- -- - {Draw existing and required addition on reverse side) ___----4_ 1 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 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 Owner Q.,.t Title;i:i4a --------------------------------------------------------------- (If other than D FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY.--:-, iR�0--------------------------------------------------- ------------------------------------------------- DATE c'_ _"_:_ t - - ------------------------------------------DATE --------------------------------- BUILDING PERMIT ISSUED _.__---- --------------------- --- ADDITIONAL COMMENTS ---- - !,. ' ----------------- - - i --------- -- - - - ---- -------------- --- --------- ------------------ ---- -------- --------------- ------------------- --- ---------------------- 4 Date ------ -------------------- --------------- -- -- - Finallnspectio by ---- # SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M