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FOR OFFICE USE: a .lD-. d-----------'// -- ---- °--� APhICATION FOR SANITATION PERMIT (Complete in Triplicate) Permit No. 7__4_- -------- ---------------- ---------- ------------ ` This Permit Expires 1 Year From Date Issued 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 c}ein compliance with County Ordinance No. 549 and existing Rules and Regulations: r JOB ADDRESS/LOCA%ON / JJ " '----- c . . � --------------CENSUS TRACT _��--- ----------- Owner's Name ----- !�lF�_' _ -- - 4 . Phone Address .__ � -._..----•----•---- -- \:UW--7---/1 0 a e �'t��----------------------------- City s�3� ,{f��7------ - --- ----------------- + Contractor's Name -- --- �-------- -------- ------- - _ installation will serve: Residence Apartment House Commercial Trailer C� � Phone --_.License #/0 '-tel I 1 ❑ Court ;❑ Motel ❑Other Number of living units:-_;At---- Number of bedrooms ---;�/---Garbage Grinder _ Lot Size/_A?Cd - .__-__ Water Supply.I Public System and name ------------------------------------ Private, Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay [:1 Peat❑ Sandy Loam ❑ Clay Loam [] Hardpan ❑ Adobe Fill Material ------------ If yes, type ------------------.......... (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 permitted if public sewer is available within 200 feet,] PACKAGE TREATMENT. [�] SEPTIC TANK' � SiSize: lf� Liquid Depth -194 �. Ca acit l?l- { - P Y --------t. Tell _ Material_�A�y�`.--- No. Compartments _---_. _ Distance to nearest: Well _------�49_�_______________Foundation -_`--_-_--_ Prop, Line ._ ,.11 _--_• LEACHING LINE' >4 No. of Lines __.__2-_------_ --_-- Length of each line-_,�Q ------ --------- Total Length 49- -0--- 'D' Box 1y � ._ Type Filter Mater!al1��pe- _-.Depth Filter Material _ i ----------•---------- -•---------- Distance to nearest: Well -3;10-------------- Foundation _ - . ------- � � ___-- Property Line .,tom__.-_---_•----- SEEPAGE PIT Depth _c -------- Diameter �---- -�J--_-____ Number __._ ---_-_.----------------- Rock Filled Yes No rC] AV Water Table Depth _-__--464'f- -----•___ Rock Size ----n - Distance to nearest; Well -----------------------Foundation Foundation --_-_ Prop. Line --a------ ------ REPAIR/ADDITION + Septic ON(Prev. Sanitation Permit# ---------------------------- --------------- Date Tank --------------------- ) ` _ --^ _---_--- P (Specify Requirements} ----------------------------- _ _ ---------------------------- Disposal Field (Specify Requirements) -------------- - ------( -- - - -------------------- - -Draw existing and required addition on reverse sid-- -e------------------------------------------------------------ ) --------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin F 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 certify that in the performance of'the-work for which this permit is issued, I shall not employ any person in such manner as to become subject to Workman's Compensation laws of California." Signed ------------------- - - - - ------ -------- --- - _ caner BY ------------------------- -------- 4=-------------------------- Title ---------- (I o e than owner) -Y--- i, ARTMENT USE ONLY APPLICATION ACCEPTED BY--- ---- BtJlLDING PERMIT ISSUED ---------- -- - - - ------------------------------------------------------ DATE -- --¢--�1`�d--- ---- --------- ADDITIONAL COMMENTS _____---� .___.. ---- - --- -- --- ---- ------------------------- --------------------------------DATE - ------------------,--------- --------------------------------------------- --------- - ---------------------------•---- Final Inspection b ------- --------------- ----------------------- ----------------------------------------------------- p y: ------ -- ......... - -- - ------- ---- -------------------------------------- ------ -------- --------- ate -- --13--� -' - �- ----- -- S JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M "`' '