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1 FOR OFFICE USE, APPLICATION FOR SANITATION PERMIT., a�7 --------------------------------------------- = No: -� ------------------------------------ -------------- (Complete in Triplicate) Date I� /C Permit ij This Permit Expires 1 Year From Date Issued s -------------------------------- - Application is hereby made to the San Joaquin Local Health District for a per to construct and install the �ivork herein Q described. This application is made in compliance with County Ordinance Na. 549 and existing Rules and Regulations: ik ---CENSUS TRACT �F JOB ADDRESS/LOCATION ._____-____-3-�-��-�-------------�------- !i -------Phone '3a_ 3-2 7P Owner's Name U�-±�c-------12� c �-------------------------- ---- ---- ------------------ Address Phone Address -5{ �"� ten-- City / --PA-�G/----------- --- j Contractor's Name ------------a__)----------- --------------------- -- License # = Installation will serve: Residence ['$Apartment House-E] Commercial ❑Trailer Court !❑ Motel ❑Other -------------------------------------------- li Number of living units:------- Number of bedrooms '. ------- Grinder �`?_---- Lot Size _ _ • - -7--------------- �. . r 1� ____--_ Private F ' Water Supply: Public System and name ------------------------------------ --- ----------------------------- ----------- - -- _ r - Character of soil to a depth of 3 feet:" -Sand❑` Silt❑ Clay -E] Peat E] Sandy Loam ❑ Clay Loam ❑ ii Hardpan ❑ Adobe'❑ Fill Material ----- ------ If yes,type ________________ __________ ] � 0 (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) I -- i De feet,) �` - Liquid d ---.----- NEW INSTALLATION: (No septic tank or seepage �# permitted if public sewer is available within 200 p � P P P -- - th --�--�---------- PACKAGE TREATMENT SEPTIC TANK 5�ze______,a -_�-- -- ------=--=---- q P' [ 7 Capacity �� ____-- Type -)Py- 'f _ Material______CGv�(',.__ No. Compartments ----- -- ---------•_-- 9 ,f ; Distance to nearest: Wel[ __ -- ---------------- - Foundation ___._/__c�_--__--_--- Propyl"me _:_ ------ LEACHING LINE [ ] No. of Lines ---------------------- g 9 D Length of each line.__________ _____ _ ____-_- Total- Length is I 'D' Box ------------ Type Filter Material --------------------Depth Filter Material ; Distance to nearest: Well -------------- ------------ ------ Property Line. ------------ ._.... ----- Rock T=illed Foundation Pro er i SEEPAGE PIT [ ] Depth ---------_____..__ Diameter ____________ Number ---------------------------- � Yes ❑ No I❑ l f ,I Wafter Table Depth ----------------------------- --------------- --Rock Size ------------------------------- i IM ----------------- Pro i� � Distance to nearest: Well'----------------------------- -Foundation p.'�Line ---.---------R---••--- 'f REPAIR/ADDITION(Prev. Sanitation Permit# ----------------------------------- -------- ! Date ---------- `------------- Septic -- ------ -- Septic Tank (Specify Requirements -_-__-------------- 1 --- --•-------------- - �. Disposal Field (Specify Requirements) ------------------------------------------------ -----------F -----._..----------- _ .. _ — -- ----- =------------------ _ _______ ----------------- {Draw existing and required addition on reverse side] 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 I "1 certify that in the performance of the work for which this permit is issued, I shall not employ any person in such manner has to become subject',VW! kman' pen ation laws of California." Signed --�-� -`- 9--- --- ----------- - ------------------------------ Owner { '} y --------- Title ---------------------------------------------..._-- ----------------- (If other than owner) _ n - _ . __, 'll FOR DEPARTMENT USE ONLY k , --------------- APPLICATION ACCEPTED BY ------------------------------- - `•-- - --------- DATE ---- ---- j BUILDINGPERMIT ISSUED ----------------------------------- ----=------------ ----------------------------- - �- ------------- r` ADDITIONAL COMMENTS ---------------------------_- - ---------- ----------------•----------- ---------------------------------- -------------- C�` ---•---------------- - ---------------- -----------Date---- - Final Inspection bY= -------------- ---------_='------------ ------------------ --------- ----- - -- - -- -- '`` SAN JOAQUIN LOCAL HEALT DISTRICT y y !' E. H. 9 1-'68 Rev. 5M