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FOR OFFICE USE: �3_-_70_ 5; -APPLICATION FOR SANITATION PERMIT Permit No. -2.494 (Complete in Triplicate) --- - -- _________________________________-.-.____..______-----------IThis 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..Thi s,a.pplication.is.made in compliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION ------ilJva _.ly_�� ,________________CENSUS TRACT _f`63-37p -C(� Owner's Name 11:,1PE----A0.1.1-!_/V .S- 1C 4d�pcl-------------------------------------- -----------Phone 41157- _'�----- Address '.---------------- ' �---------------------- -- -----------•----------------- - -------------------. City ---sem-�'-�--f---�d Contractor's Name .-/1� 5____._: 'r/ --------S ----------------------------License # /2-7,$-4'-3--_ Phone l � S -��--- Installation will serve: Residence ❑Apartment House,❑ Commercial ❑Trailer Court ;❑ Motel ❑ Other _1_J---------------- Number of living units:------------ Number of bedrooms ------------Garbage Grinder ------ Lot Size .ZC __�2e?5------------------- r �� m --------------- --- -- - ----• W Water Supply: Public System and nae ------------------------------------------- ---------------------------------------Private ❑ 4 Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ 1 Hardpan ❑ AdobeA 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 [ 7 SEPTIC TANK Size__ _ _S -------------- Liquid Depth 4/-_'__________________ Capacity/�D17eZe,'� Typerl�� 9"Material,e:�l-W-ef _ -No. Compartments _______________- - I Distance to nearest: Well ___________________________________Foundation __1�,l -Prop. Line __,5 ____.._._____. LEACHING LINE [ ] No. of Lines ------------------------ Length of each line---------------------------- Total Length -----------_--------_--_---_ 'D' Box --- --- ---- Type Filter Material --------------------Depth Filter Material -------------------------------------.____.. Distance to nearest: Well ------------------------ Foundation --------------------- -- Property Line _________-_-____--:____ SEEPAGE PIT [ ] Depth -------------------- Diameter ---------------- Number ----------------- ---------- Rock Filled Yes ❑ No IQ Water Table Depth ------------------------------------------------Rock Size -------------------------------- Distance to nearest: Well ________________________________________Foundation --------- Prop. Line _-__.___________-_..-_ REPAIR/ADDITION(Prev. Sanitation Permit# ------------------------------------------- Date -___--__--____.______________-----1 Septic Tank (Specify Requirements) __plena -------Alm----7�?%tw&------ fJ`�?�---,1 Q(7_---C L�jr��' --------- DisposalField (Specify Requirements) ---------------------------•--------------------------------------------------------------------------------------------------------- 1 ----------------------------------------- - (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 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 shell not employ any person in such manner as to becom'� subject to Workr an's Compensation laws of California." Signed - �__--- -------------------------------------------------------- Owner BY ------------ ----- ------------------- ---------------------------------------- --------------------- Title -------------------- -------------------------------------------------- (If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ___-- _ - - ----- - -D- __--_ -- -------------------- DATE ------ - -- --�-__fes-- BUILDINGPERMIT ISSUED --------- -------- -------------------------I___----- --- -------------------------------•--------------DATE - --•----------------------------- ADDITIONAL COMMENTS -------------------------------------------------------------------- -------------------------------------------------------------------------------------------------------------------------------- ----- ------ ------- -------- ---------- --- ---- ---------------------- e ----- - -- ---- Fina! Inspection by: Date ---- --r ------ --- SAN JOA UIN LOCAL HEALTH DISTRICT E. H. 9 Z-'68 Rev. 5M. i