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FOR OFFICE USE: 0 -7 5i co YYl� APPLICATION FOR SANITATION PERMIT `l©_6CI3 --------------------------------------------------------- �Zt� (Complete in Triplicate) Permit No: -- _________________________________________________________ This Permit Expires 1 Year From Date Issued 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 application is made in compliance with County Ordinance No. 549 anexisting,�u es and Regulations: JOB ADDRESS/LOCATION -----------------CENSUS TRACL!' -�o�7Owner's Name ----�-e�-r7.!1----l----- --��------�-`--�-----------------------------------------------------r---- -------------�ne�37---�4� Address _LRQr � /-G =� City _L.i_aE �� r-" --------- -- Contractor's Name1Y1�_ll.l�'_ _ / vee ___.License # _ _ Phone - �. -�. Installation will serve: l Residence Apartment House,❑ Commercial []Trailer Court ;❑ Motel ❑Other ------------------------------------- ...... 60 Number of living units:----- Number of bedrooms _-_____''Czarbage Grinder __ -__ Lot CSize _p_____--------------___�_�'�_-_-•___•,,_ _ LSC -!< Water Supply: Public System and name ------------------------------ '`` �`ei ►� Private E]Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat❑ Sand Loam (] Clay Loam ) Hardpan ❑ Adobe ❑ Fill Material ____________ If yes,type ____________________________ 1 (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 se age pit permitted if public sewer is available within 200 feet,) p pe PACKAGE TREATMENT [ ] SEPTIC TAN Size��A - 10��I _________ Liquid Depth -__�t3__- Capacity MOO------- TypePeW_ %CT_ Material� No. Compartments Distance to nearest: Well 1_04A_----------------------- _Foundation ___ P---------prop. Line -------0............ LEACHING LINE V No. of Lines ____1_______________ Length of each line-__t �_____x_._--__ Total length ._-- .p-� . D' Box ___________ Type Filter Material 4epth Filter Material ___._1_______ �.________________---_.-_---- _ Distance to nearest: Well ��__________ Fou ation _1 _�________ Property Line_ ------�_---*___.._ SEEPAGE PIT [ ] Depth -------------------- Diameter ________________ Number ----------------- ---------- Rock Filed Yes '❑ No i❑ Water Table Depth ------------------------------------------------Rock Size --------------------_--------- W Distance to nearest: Well _______-________________________ ____Foundation -------------------- Prop. Line ...................... VA, REPAIR/ADDITION(Prey. Sanitation Permit# ------------------------------------ ------- Date __________ ________..._.._______) Septic. Tank (Specify Requirements) --------------------------------------------------------------------------------•------- ----------------------------- DisposalField (Specify Requirements) ------------------------------------------------------------------------------------------------------------------------------------- -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ------------------------ ------------------------------------------------------ --------------------------------------- ---- ----- - ------------------------------------------------------------------------ (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- at in the perfo nce of the work for hick thispermit is issued, I shall not employ any person in such manner as to be a subject t r an' the laws of ifornia." Signed - - --- --------- ----- By ----------------------- --- ------------------------------------------- - --------- ------- ---- Title ----- ----------------------------------------------- (If other than owner) FOR DEPART ENT O L APPLICATION ACCEPTED BY ' 1`/-1 DATE ----- - e-3------------------- BUILDING PERMIT ISSUED ---------- - - ----------- ---DATE ------------- ----------- ---------- ADDITIONAL COMMENTS ----------- ------------ -------------------------------------------------- ---------------- -------------- ------------------------------------------------------------------------------------------------------------------------------ - - ------------------------------ -- Final Inspection b ___________________ _ ------------- Date _____ .__ rc9-- - -------- --- - - -- P y: -------------------- ----------------------------------------------- --- 7 - ------------ SAN JOAQUIN LOCAL HEALTH' ISTRICT E. H. 9 1-'68 Rev. 5M