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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT - ----- -------------------------------------------------- - �8 Qom/ (Complete in Triplicate) Permit No. _.____fir_____.. -.. -- This Permit Expires 1 Year From Date Issued Date Issued �a-= 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 and existing Rules and Regulations- ---------- egullations- JOB ADDRESS/LOCATION ----"!_ �: __%-__ _ J�• =(OW _ I / " �'J . ------ - -- -- -- -CENSUS TRACT .----------- Owner's Name ----- --------------- --------------------------!-Phone,0-,a--J'—------------------ Address �__._ _ -kity -------------------------------------- -- L�, Contractor's Name __ .- _ � _________ . �-_Z2-7" f�/1rT� �Y' - ---------.License # i Phone Installation will serve: Residence ( partment House❑ Commercial :❑Trailer Court ',;❑ Motel ❑-_ Other ---------------- ---- --•------------ Q Number of living units: L__�_--__ Number of bedrooms--_-_--Garbage Grinder Lot Size ------------------- Water Supply: Public System and name --------1--------- --------- ------ ,a private Character of soil to a depth of 3 feet: Sand&r Silt C] Clay E] PeatE] San0y Loam E] Clay Loam ❑ w Hardpan ❑ Adobe ,0 Fill Material;&F5_ If{ye,type'- _!�,,Voqm (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.permitte;a if public.sewer is available within 200 feet,) PACKAGE TREATMENT { ] SEPTIC TANK�[� r� Size--3? -t�(` ��--7��---------- Liquid Depth ----------------- Capacity --,-- -Capacity LAPP_._,__ Type�" R __ Materiai'n L No. Compartments Distance to nearest: Well -15,-o_ _______________________ Foundation fQ______--__---_ Prop. Line ........ LEACHING LINE No. of, Lines _ M .- e r f [1]� a �----------------- Length of each `linea'- 5------ Tota! Length�,.. _.---X15---- j 'D' Box ------------ Type Filter Material ------Depth-Filter Material F/---i�__ -----•---------------------- Distance to nearest: Wehl __= Q_____________-Foundation 1149__-_-- ----------- Property Line. -___......_--__.__-_____ SEEPAGE PIT Depth __.//---^......... ----_-I__-__--____ Rock Filled Yes e No 0 Water Table Depth ----1/5—-------------_-------------------Rock Size -Ig__ f - L Distance to nearest: Well---------------------------------------- _Foundation;--_---------------- Prop. Line ---------------------- REPAIR/ADDITION(Prev. Sanitation„P,.ermit# ________ ----------------------------------- Date ---------- -------:------- ) Septic Tank {Specify Requirements)r., ________-_--_'. ---------------------------------------------- ---- •----------:-----------------.:_--------------------------- Disposal Field (Specify Requirements) --------------------------------------------------------------------- irt ----------------- --------------------------- ----------- ---------------------------------- i ---=-----------L X-f-t{-------------T---------------------- ----------------------------------=---------------------------------------------------------------- ------------------------------------------------------- ------------ --- ------ ---- --------------------------------J --------- ------------------------------------------------ i' (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 Rulbs and Regulations of the San lJoaquin-Local Health District. Home owner or licen- sed agents signature certifies the following: '- "I certify that in the perfori6ance of,the work for which this permit is.issued, 1_.shall, not employ any_person in such manner as to become subject to Wir kman's Compensate.on_laws--of California." ----.�- Signed - ------------------------•-- --- "Owner Y --� - �__,.� ��ner ---- -- Titl ��(If otherthan FOR DEPART-WISIVUSE ONLY APPLICATION ACCENTED BY'-:------------- - ---------, DATE -- -_-,. __ -----_.-----,------------ ---------_--------- ----------- ------------- ---------- BUILDING PERMIT ISSUED ------------------------------------------------ - --- ----------------------------- --- DATE-_..---------------------------------------- ADDITIONAL COMMENTS / /'� yYJ �j � � 9C --- - �L ' ? -------------- p -T------- «' - -- --- __-5--fir -- -�- ---------------------------------------------------------------------------------------------------- ------------------------------------- - ------ - ------------------- - -------,--------------------------------------------------------------------------- -----------�---- ------- ---- - - - = - - - Final inspec ' ---Date ---- -- ----_--� -- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M r