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FOR OFFICE-USE: APPLICATION FOR SANITATION PIES ------ (Complete in Triplicate) Permit No. __�-L.-S- --- -. ____ This Permit Expires ] Year From Date Issued Date Issued Application is hereby made to the S Joaquin Local Health District for a permit to construct and install the work herein described. This applicatio i d r compliance with County Ordinance No. 549 and existing Rules and Regulations: / � sq JOB ADDRESS/LOCATION .- r-- -�_ ----- ,--)--- - --------- -----------------------CENSUS TRACT �. Owner's Name - - - ----_ d_�"�fE , g p/ (�- ------------------------------------ - ---------•------------ --- --Phone 7,'�9-J6--l-fsf----------- Address --_--_• Cit �.r_r�•_j._ _ .} ------ ---------- -- -•- ----• -----•------ ----------------- - Y - �'1--IR-1'111- -------- ---•----- •-•- •-- Contractor's Name -1M-*._-7 _,r_R-----_ _It-PI-t'C- TA--A/)f--S icense # A-4`0 X-4 Phone Installation will serve: Residence Apartment House Commercial []Trailer Court i❑ Motel ❑Other -------------------- - Number of living units:----I------ Number of bedrooms __ _ ______Garbo a Grinder _...1�_----- Lot Size ___ _ -- Garbage G 'G tp------ -1 Water Supply: Public System and name -----------------------.------------- ---------------------------------------Private [� Character of soil to a depth of 3 feet: SandE] Sift❑ Clay P Peat❑ Sandy Loam l] Clay Loam 0 Hardpan ❑ Adobe ❑ Fill Material ------------ If es, t O (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,) k PACKAGE TREATMENT { ] SEPTIC TANK [ ] Siz �_ Q G____ =�C . Liquid Depth -_____ ��++ Capacity �itG- ---- Type - y u t ___________________ No. Compartments ___�___.......... Distance to nearest: Well --, - --a-------------------Foundation ---------------------- Prop. Line .--------- LEACHING LINE [ No. of Lines ___ _____ __________ Length of each line------ 4710--____._____ Total Length -----J.X_0--- 'D' Box.,--4------ Type Filter Material 4-K-A---lAepth Filter Material -----------1-2----- Distance to nearest: Well ----3--i,Q ---K Foundation ---------- -------- Property Line ----------------------_ SEEPAGE PIT ( ] Depth iks--1-----------\Diameter 11 Number ------------- Rock Filled Yes Z,,, No i❑ 4Ya, Water Table Depth -------------------------- --_- , ..---Rock Size >3-_X-_4_ ---------------- Distance to nearest: Well ___- _-O_________________--Foundation -------------------- Prop. Line ______..__-___-_. REPAIR/ADDITION(Prev. Sanitation Permit# ---_---•-------------------__--------------- Date ----------------•_---- -- _ Septic Tank (Specify Requirements) ------------1_ --0 d-__-- ta_----- Disposal Field (Specify Requirements ----- _ .-Q-__ ------------- --------------- "'ti ----------------------------- ------------------------------------------------------------ - (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 Rules and Regulations of the San-jud?euin Local Health District. Home owner or'Ri en- 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 ------------------ ------------------------------------------------ Owner By -- ----- - --------------------------------------•---- 4 - ------------------------------ Title ---e- ,41- - (If other than o r) - FOR DEPARTMENT USE ONLY DATE -� - --------------- - ------ ._..__ APPLICATION ACCEPTED BY -� ----- BUI LDING PERMIT ISSUED ----------- -- DATE - ------- •-- ADDITIONAL COMMENTS --------------- - -'----' ------------------------------------------------------ ------------------------------------------------ -------------------------------------------- ----------- - - -- --------------------------- 1. ----------------------------------- -- --- --------------------------------------------------------------------------------- Final Inspection by: - .__ - --- - -- - - -�--- ----- ------------ ------------ •------ -----------------------------Date _.��-�- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M