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` FOR OFFICE USE: ,o APPLICATION FOR SANITATION PERMIT _ ------- !- -- -------------------- ----- Permit No: (Complete in Triplicate) --------------------------------------------------------- This Permit Expires 1 Year From Date Issued Date Issued ' Application -is hereby made to the ISan Joaquin Local Health District for a per to construct and "install the work herein described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: 20Sa4 � p -- Saa!'fi JOB ADDRESS/LOCATION ------ !` - ---Tv e_____ - (-_------_ ,----lZ�----C�.�ry F----------CENSUS TRACT -------- ---------------- r I Owner's Name --- � ►"M_S b/ =-------------"_.'`�' Phone ,: y� j - .- Address -----=�---- � --_4� -------��----�------------o--------- ---------------•--- City --�- 1/_�_'_�r__�G_ Phone _.5_�3 ------ Installation y�•, QS C� ( T7?� � F T -- -- --------------------------- --------------------- Contractor's Name /Y------------------------------- # I Installation will serve: Residence ER Apartment House❑ Commercial:❑Trailer Court ❑ i Motel ❑Other -------------------------------------------- Number of living units:----- Number of bedrooms ---3_____Garbage Grinder Lot Size 9 Water Supply: Public System and'name- ---------- -------------------- ---------------------- - � ------ ---.`..'---------------------------Private Do �. Character of soil to a depth of 3 feet: Sand Silt-E] .Clay ❑ Peat❑ Sandy Loam •(] Clay Loam ;❑ " Hardpan ❑ 'Adobe•❑ Fill Material If yes,type ---------------------------- 4 ___________________________ i 4 (Plot plan, showing size of lot; location of'system#in relation"t wells, buildings, etc, must be placed on reverse side.) f* NEW INSTALLATION: (No septic:tank,o seepage pit,permitted if public sewer is available within 200 feet,) 0 i PACKAGE TREATMENT[ ] SEPTIC•TANK f ] Size----------------------------------- ------ Liquid Depth -------- _-:---- i .- w. Capacity'-'-- ------------ Type ---- -=---------- Material-------- - Na. Compartments" --------------•-•-`----:z'., , } f g.---------------------- Foundation - prop. Line =- -r ------------ ---- --4 _ ...w 5 t Distance to nearest: Well m LEACHING LINE No. of Lines F --___--- Len th of each"line---------------------- Total Length :-------------------•----.._7r F _ ______ Depth Filter Material De --:D'—Box-- _, __-_._ Type Filter Material ____________________ p _ __ _______ .-- .___________--__ :.. . .,... -a .. r� a +J , 'Distance to nearest: Well-4')• "i_ _-- _¢-------- Foundation _i_ _}-L `_-_-=- ---- Property Line ---- •------------ --=" 4 SEEPAGE PIT Depth Y _ Rock•Filled Yes No. C]-, 1 p Diameter. ` ----- -- Number- - ❑ �❑"' Water Table Depth ------------------------------------------------Rock Size ---------------------------- Distance to nearest:.Weli ----------_t -=---------_ r-------Foundation -------------------- Prop: Liner-_:.--:----_-•- EPAIR/ADDITION(Prev. Sanitation Permit# -----------/�'_�°�1' .---------------------- Date ---------------------------------•1 Septic Tank (Specify RequiremenTs) --------to Q �a -�f�-�1 w----------- :------------------- _ ' 'r Wit" }r1�i -------------------- Disposal Field (Specify Requirements) ----- /_.__ �Q � ^ �r /Yl a r2 f�C' l G r i.vo *• R ------------------- ----------------------- ------------------- �--� AS� Y - - - ----- �xV5nXE- L CH---4A6-- ----- T-- (Draw existingararequired 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 and Regulations of the San Joaquin Local Health District. Home owner or licen- sed agents signature certifies the following: i "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 becomeAubject to Wo an's Compens tion laws of California." f , Signed .. 2 ---�V`-\--------------------------- Owner BYLei ---=- ------------- •---------- ----------`Z. Title --------- ------------------------ ------------------------------ (If other tlianr FOR DEPARTMENT USE. ONLY ` APPLICATION ACCEPTED BY --------------------� --------------=------------------ -------• DATE ------ BUILDING ----BUILDING PERMIT ISSUED -------------------------- ---------------------------------------------------------Z-----------------DATE ------------------------------------------ ADDITIONAL COMMENTS '------------------- = --------------------------------------------------------------------•---- --------------- -- --- -------------- ------- - --- __6 � --- ---- -- � Final Ins ection by: -- - - - - - - ---- ------ -- Date I SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M