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Vfi /_-17/ FOR OFFICE USE: - APPLICATION FOR SANITATION PERMIT Permit No:` - ----------- {Complete in Triplicate) --------------------------------------- .. Date Issued w(,( -1 , This Permit Expires 1 Year From Date issued Application is hereby made to the San 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: i S ----CENSUS TRACT -------------------------- JOB ADDRESS/LOCATION . -Tip "L R`f y Owner's Name ---- ----- -------Phone ------------------------------------ �1.xw.+e�rt�7-----�- - �� --�T�---------------------------�- ---------------•----- Address - City -=----------- ------ `�-------� -------- -A G... asp-�-------- �-------------------------------------- ,rya Contractor's Name - °--0kJIvf,P"'---------------------------------------------------------- -----License # ---------;-------------- Phone ----------------------------- Installation will serve: Residence g Apartment House L❑.Commercial ❑Trailer Court ,❑ Motel ❑Other --------------------- --------------------- g Vis.. Lot Size -------��--/4-`- - Number of living units------------- Number of bedrooms .._ _. _._._.Garbo a Grinder _ - - ----------•---...---- Water Supply: Public System and name ------------------------- Private ] Character of soil foci-depth of 3 feet. Sand`Eja Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay LoamZi .g, ' Hardpan F1Adobe '❑ 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.) NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) ` I N, PACKAGE TREATMENT [ ] [ ] 16 _ Li Liquid De th -- 1�z-----,----- SEPTIC TANK' Size q p Ca a'cit 12,00 �a.) TYPe �=°ry` � S Material.__ .°nc"-�fp No. Compartments -----.-....-----••--- L�� p• Y " Distance to nearest: Well ----10-6------- - --------Foundation ---10------------ Prop. Line -- -----••----------'\ D - ------ Total Len /G Cy LEACHING LINE ' [ ] No.s of Lines --------&------------- Length of each line------------------- Length 'D' Box -----l----- Type Filter Mafierial /�-Z_�+s�J'eut[3epth Filter Material - -----f 9 " --•---------- v�\CJ ' --- Property Line. Distance to nearest: Well ----- �------------- Foundation .... SEEPAGE PIT [ ] Depth ----------------- -- Diameter ---------------- Number .--:------------------------ Rock Filled Yes ❑ No .0 P Water Table Depth Rock Size ------------------------------- E � Distance to nearest: Well --------------------------'-------------Foundation -------------------- Prop. Line --------- ----, REPAIR,/ADDITIQN(Prev. Sanitation Permit# ---------------------------- Date ..___-.._-.------------------- Septic Tank (Specify Requirements) --------------------------------------------`-------.----------- ----- -. -----------� --------- Disposal Field {Specify Requirements, -- - Q' ------ '4 �' ` C 6 ------U-et------ ru>t �= " --------------- - ------------------------ ------------------------------------------------------------------------------------------------- (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 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, 1 shall not employ any person in such manner i as to become subject to Workman's Com ensation laws of California." ' Signed Owner v ------------- Title ---- --------------- --------------- ---------- ------------------------ f (If other than owner) FOR DEPARTMENT USE ONLY �o _ DATE _-�z'.�g=_��- ----------------- APPLICATION ACCEPTED BY -----_ -`- ---- ----- ---- BUILDING PERMIT ISSUED - -- DATE ------- ----------------------------------- ADDITIONAL COMMENTS ------j ------� � -------------------------------------------------------------------------------------- � cfrh ------------------ -------------------------------------- --------------------------------------------------------------------------- -------- ------------- - - - ----- ------ --------------------------------------------------------- - ----- ----------- ---- ------------------�------------- - - ---- --- --- ---- Final fns ection b -� -----------------Date ! ' SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M. -