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FOR OFFICE USE: a /N6 APPLICATION FOR SANITATION PERMIT `.• r Permit No. � � ,} {Complete in Trip k fe) riDate Issued J,__________ _____________________ _ _--- __ Fj _ This Permit Expires 1 Year From Date Issued Appli,lation 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: JOB ADDRESS/LOCA I6�_ . : -C _ f1_ ---CENSUS TRACT ------------- ----------- 97 ----------- -------- Owner's Name Phone -j Addrss - l�C ��✓?G�--------------- Cit - _ _ ' Contra � Contractor's Name --..__-_. k�C �------- C ---------------------------------------License # P Installation will serve: Residence fYApartment Oouse[) Commercial ❑Trailer Court El Motel[}Other^ '-ocr----------------------- r r Number of living units-------- ____ Nurfnl�er of bedroo s�j______Garba, e Grinder �j�.�-- Lot Size �G-JL----- _ ------------ Water Supply: Public System and dame --- ---------------------------------------------------------------------------Private Character of soil to a depth of 3 feet' Sand'❑ SldobeW t❑ Clay ❑ Peat ❑ Sandy Loam ❑ Clay Loam ❑ I I It p ❑ N Fill Material ------------ if yes, type ---------------------------- Hard an (Plot plan, showing size of lot, location of±sysstern in relation to wells; buildings, etc. must be placed on reverse side.) k. NEW INSTALLATION: (No septiAtar k or seepage pit permitted if publ a sewer is available within 200 feet,) P ., 1. PACKAGE TREATMENT [ SEPTIC TANK [ ^ Size._____ _ __ -_ _.__-___-___ Liquid Depth ---- 2, 0, d J I �R"- _. Capacity _ _�_ .�._ Type, __/3�___- `� Material__ _l.'e—W �Io. Compartments _ �___ Distance to nearest: Well --- � ______________________Foundation ----f-0-___-------- Prop. Line _ .............. LEACHING LINE [ No. of Lines ------------- - Length of each line- IWA.-'24-____ Total Length : -f-___________- D' Box _V . e Filter Material' ` S_ �- p Filter Material _ __ u Type �-Lf �� h ----- Distance to nearest: Wel! _ ___��_____`_.___ Foundation - __ ______________ Property -Line.,___]................ . SEEPAGE PIT, I Depth __� _______ Dia eter 3-__�_-___ Number ________________ Rock Filled lyes No f0 fY Water Table ep h,.- ------------- Rock Size\) `"�3lf------- � Distance to nearest: Well ______/+ZI-47-------------------Foundation _____f----- ------ Prop. Line ................. REPAIR/ADDITION(Prev. Sanitation P Rit# -------------------------------------------- Date ---------------------------------_) Septic Tank (Specify RequirementJ. --------------- - --------- -- - ----- --------------------------------------\-----------:---------------------------------------------- Disposal Field (Specify Requirem-e nts) ---------------------------•--------------------------------------------- 4 --------------------------------------•--------------- ------------------------------------- --- ---------------- --------_-------------------------------------------------------------- f .. ... _..___..71: � r q = - --------------------------------------------- �f i f Draw existingand required addition on reverse sidel `; { I hereby certify that 7"h ve prepared this application and that the work will be done in accordance with San Joaquin te Laws, and Rules and Regulations of the San Joaquin Local Ordinances State l Health District. Home owner or licen- sed agents signdfure certifies the following: } "',I certify that/in the pe4ormance of the work for which this permit is issued, I shall lot employ any person in such manner -Wo become subject to Workman's Compensation laws of California." Signed --- ---- -----------------(----, .� Owner .� B � — 11'- -- -- Title ---------------------- Y ---------------------------------- -- ---------- ----------- (If other t o r) I I FOR DEPARTMENT USE ONLY o APPLICATION ACCEPTED BY �---------------------------------------------------- DATE ---- �" a- ----------------- I UILDING PERMIT ISSUED ----- --- -------------- ..--------------------------DATE -------------------------------- ---------- ADDITIONAL COMMENTS -- -------------------------------t------------------------------------------- ---- --------------- ------------------------------------------------------------------------------------------------------ -------------------------------- o ----- i 9 FinalInspection by: _ --- ----- - -- -------------------I------------------------------------------------------------Date --- 1�' 1 ------- SAN -----SAN JOAQU N LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M.