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FOR OFFICE USE: }' APPLICATION FOR SANITATION PERMIT �} Y s tC -------- -------------------------------------------- (Complete in Triplicate) Permit No: ----- ----------- ---------------------------------------------- / -zDate Issued -c7- - - --- _ -----_----------- --------- This Permit Expires 1 �br From 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 OrdinpnCpNo. 49 and existing ul and R lotions ��ra �• ��. JOB ADDRESS/LOCATION . 17w!- ,------- ---- -- -- CENSUS TRACT — f II �C7 C`'f' � f --------------Phone -V 73-r_76_�j- -✓ Owner's Name :k' DI --------------�?-ifl- a--------- _ `Address Q�-_/ ....-- -�`�}- '----------------------------------------------- City -MAI G f¢------------ r! t`� 'f LJ�p------- - 'C- License # 4F*17 --- Phone'-4�� Contractor's Name - '�-r =I'--- :Installation will serve: Residence ❑ Apartment House,0 Commercial :❑Trailer Court ❑ �' Motel XOther ------------------ r• `Number of living units_____________ Number of bedrooms ------------Garbage Grinder ------- Lot Size ------------------------------.------------- �. Water Supply: Public System and name ---------------------------------------------------------------------------•--------- ------------------------Private ,? Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat❑ - Sandy Loam Clay-Loam ,Hardpa.n,❑ .�:Adobe_❑Fill,Material_ _-.---_ _ If�yes,tXP_e�-- : -------_.--..=-�-: -w.,..�- (Plot plan, showing size of lot, location of system 'in relation to wells, buildings, etc, must be placed on reverse side.) "t NEW INSTALLATION: (No septic tank or seepage pit permitted if ,public sewer is available within 200 feet,) PACKAGE TREATMENT SEPTIC TANK Size-� o�__.��/"---��----------- Liquid Depth -------------------------- Capacit vwn----_--- Typk'e-A1'S_rMaterialOeWti----- No. Compartments Distance to nearest: Well ) -----------------------Foundation _4166--- Prop. Line LEACHING LINE No. of Lines ----// Length of e li ____________ Total Length`--_ �-[ ........... D' Box ._ ------- Type Filter Material Depth Filter Material _ �__-------------------- w_-_... Distance to nearest: Well/ FFoundation -------------- Property Line --_ - .f .-- _ . SEEPAGE PITDe th L 1 P ------ --------- Diameter ---------------- Number ---------------------------- Rock Filled Yes F] No iWater Table Depth -------------- ---------------------------------Rock Size ----------------------------•--- z" Distance to nearest: Well ----- ---------------------------------Foundation -------------- ---- Prop. Line ---------------------- REPAIR/ADDITION(Prev. Sanitation Permit# --.------------------------------------ Date --__-_-----_--.-------------------} Septic Tank (Specify Requirements) ---------------- --------------`----------------------------- ' Disposal Field (Specify Requirements) ------------------------------------------------------------------------------------------------------------------- --------------- e -------------------------------------------------------------------------- --------------------------------------------------- --- ---------- ---------------------- ------------------------ - ------------------------------- � Draw�ex�istin ( 9-and, q revired�additron-on,reverse°st e) '-- -_ 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:.4 "I certify that in the Performa of the work for which this permit is issued, I shall not employ a�ny.person in such manner as to bec a sub'ect�to r n's Camp ns o laws of California." i _ Signed - --------•-- --------------- --- -----�---,---------Y---- Owner BY =` Title - ------------------------------------- ----------------- (if other than owner) _ R FOR DEPARTMENT USE ONLY R �' APPLICATION ACCEPTED BY -------------- -- ` DATE __�------ --------------r�Q-------•--------- BUILDING PERMIT ISSUED ---------------------------------- --------------------------------------------------------------- DATE ---------Z-F---- ADDITIONAL COMMENTS --------------------------------------------------------------------------------------------fi------------------------------ . ---- ------------------------------ ----------------------------------- -------------------------------------------------------'------------------------------------------=---------------------------------- --------------------------- - ---------------------------------------------------------------------------- -----------------------------------------------'---------------------------------------------------------- ---------- ----------------------- --------------------- = FinalInspection by: ------------------ 'C - _- ------------------------------------------------------------Date -- ---w--------- ---------- SAN JOAQUIN LOCAL HEALTH, DISTRICT 0 E. H. 9 1-'68 Rev. 5M.