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FOR O0[tE USE: - y - APPLICATION FOR SAN)TATION PERMIT -------- -- t------------------- (Complete in Triplicate) Permit No. ------- -------- ------ Date Issued -- {' -23 -- This Permit Expires ] Year From bate 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 and existing Rules and Regulations: - 0 JOB ADDRESS/LOCATION �� i ( CENSUS TRACT Owners Name ---------- 'i t/ C� 1`� -------------- --Ph Address _.._i--��--�-� 1._�_.-. . ij L�_�- Phone ------------------------------------ ---------------------- -- ------------------ ---•------- n -- Cit f } - Contractor's Name1JU'-i�f ' - ---.License # ---------------------- Phone --------- installationwill serve: Residence ©Apartment House❑ Commercial:❑Trailer Court ;[J ! t Motel ❑ Other - --------------------------------`= Number of living units:.__. ------- Number of bedrooms ----- Garbage GrFWer [7_. Lot Size ----4-jC� Water apply: Public System and name --------------- - •------------- ---------------------------------------------------Private C aracter of soil to a depth of 3 feet: Sand'❑ Silt Ej Clay o- y ❑ Peat❑ Sandy Loam ❑ Clay Loam.Z]_ . Hardpan 0 t�a',;gdcb'.e Fill Material"_----- - - - - _ : --- If Yes, type ---------- ----- -- .- (Plot plan, showing size of lot, location of system in relation to wells' kuildings, etc, must be placed on reverse side.) I i NEW INSTALLATINZ ON: I(No septic tank or seepage it permitted if public sewer is available Nifithin 200 feet,} � PACKAGE TREATMENT + f l SEPTIC TANK'[ Size- Ct ;. 1 -------------- -- !qui Depth 1_ IJ Capacity - --------------- Type -- -- - d p Material ------- No. Compartments ---------- i' g Distance to nearest: Well - I------------ - -- --------- f=oundation ------------- -------- Prop. Line ---------------------- - ------ LEACHINd LINE [.I No. of Lines ______________ ___ __ _ Length of each line--___--_--_____-__ + _- T tal Length + +a D" Box -_;�_-__- Type Filter Material --------------------Depth Filter AMateri I . _ 34 I -------- ----•--------- SEEPAGE PI d# Distance to nearest: Wel! -- -.-_- �^ Foundation , .",- -� ------- Property Line 0 No ter ------- -------- Number _.------------- es-- -_- Rock Filled Yip --,. 1 ( Water Fa Depth -------- "� --------------------------------Rock Size E Distance to nearest: Well --------------- ---------Foundation _---.----- REPAIR/ADDITION(Prev. Sanitation_P.ermit,#�*,_:: Prop. Line _______________•______ I ---------------------------------- Date --------------------- -----) Septic Tarek (Specify Requirements) _._---__ - 11 ! ------- ' Disposal Field (Specify Requiremehts)—:70 -- _ r� -- --------- ---------------- �t r ' �C>� r j � cn -------------------------------•--------------- L. --- w ----------- ( - ----------- --------------------------------- = (Draw existing and required"gddition on reverse-'side)- ^ = - _ 1 hereby certify that } have prepared this application and that the work will be done in accordance with San Joaquin Caunfyf Ordinances, State Laws, and Rules; and Regulations of the San Joaquin Local Health District. Home owner or licen- sed agents signature certifies the following: zl+ ) j<1 ,a t; "I certify that in the performance of the work for which this permit is issued, 1 shall not em Io an as to bt come subject to Workman's Compeinsation�laws of California." it p y Y person in such manner Signed !-. --- ..; - ---------------- Owner t (If other than owner) ;--------------------------- Title ------- -------- -------------- E; FOR DEPARTMENT USE. ONLY APPLICATION ACCEPTED BY - �t_ -0 BUILDING PERMIT ISSUE[a -___ -::-:. = DATE -._ _.- --` _�� ----- ------------- ----- ADDITIONAL COMMENTS _-_. �:-_. :, _ _ r-._- :.- DATE -------------- - - -- :r ------------ &;� ------- ----------------------------- Final Inspection ------------------------------'-----'-'_.-- Final Date �,7 -' . .: SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M �t