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T& &c FUSE: � � APPLICATION FOR SANITATION PERMIT w (Complete in Triplicate) Permit No. - -- -- `� This Permit Expires 1 Year From Date Issued Date Issued __!P__--_U_q 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: of 827 i� JOB ADDRESS/LOCATION :�I_ � ---- ------�QN ---�j4 ----- --------------------------CENSUS TRACT ----- ---.-------_--- �r�-----1h.4 t�' - 1 ---------------------------------------- Owner's Name -------- -- --�- - -------------------------------------------------- -------------- hon ---- ------------•-- �■ � ----------•---- Address ----��' _ __---•---------Rj :�„_------- ;� ' CitY , _�C�t -- Contractor's Name ---WA0,b�f--------------- _ -------' ---------------------License # ---------.-------------- Phone __5X7:57%.---- ---�-----�;�- Installation will serve: Residence_�<artment House-E] Commercial ❑Trailer Court ;❑ IMotel El Other -------------------------------------------- Number of living units------i______ Number of bedrooms 3________Garbage Grinder VJ _ Lot Size _/4_ R1 ________________ Water Supply: Public System and name ----------- - - Private Character of soil to a depth of 3 feet: Sand'r Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ Hardpan ❑ Adobe-E] Fill Material If yes, type ____________________________ (Piot 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 [�j� Size_&__X I D___X__.___ --------------- Liquid Depth _ / --______. Capacity 1.500-----_- TypePRIFE - _ Material--- ---- --- -------- No. Compartments ------ I l ' Distance to nearest: Well ------ ---_-.____.Foundation --- __._ Prop. Line _S_--____________ LEACHING-LINE -[Al"�'No. of Lines ____--___- Length of each--line._=___:_75__!A__._-.___ Total Length i*__1_Sa-----_ 'D' Boxy_E?_ Type Filter Material Pq4; �___.__-Depth Filter Material .-___-/9_________ Distance to nearest: Well __ d ___ �____: Foundation �Q_'___ -:___-- Property Line -E__..__+------- SEEPAGE PIT [ ] Depth ________ Diameter ______________ Number ___________________________ Rock Filled Yes [] No ❑ Water.Table Depth ------------------------------------------------Rock Size -------------------------------- Distance`to nearest: Well ---------------------------------------Foundation __.______.__..-- --- Prop. Line ________-.___--_----.- REPAIR/ADDITION(Prev. Sanitation Permit -----"-Ddte Z- ----} Septic Tank,(Specify-Requirements) ------------------- -------------------'------------------------------- --------------------- ------------------------------------ -•---- Disposal Field (Specify Requirements) _________ '� ----------- -------------- --------------- --------- -------------------------------------------------------- ---------------------------- ------------------------ --- = .6 (Draw existing and required addition on reverse side) t,.X I hereby certify that I have prepared this application and that the work will he done in accordance with San Joaquin County Ordinances, State Laws, and Rules and Regu4atigns•of the San Joaquin'Local Health District. Home owner or licen- sed agents signature certifies the following: ,- "I certify that in the perform"ce of the work for which this permit is issued, I shall not employ any person in such manner to j man's Compensation laws of California." Signed atom su act to or Owner BY - ------------=------------ ------------ - -- _ -----------------------------Title T= (If other than owner) FOR'DEPARTMENT USE ONLY - APPLICATION ACCEPTED 8Y --------_____ �i`\ " _ --------------------------------------------------------------------- DATE --------------------------------------.---- BLlILD1NG PERMIT ISSUED - -- --------------- ------------------------------------------------------------------------DATE ------------- - - -- ADDITIONALCOMMENTS ------------- -------------------------------------------------•--------------------------------- ------------------- ---------------------------- - ------ -------------------------------------------------------------------------------------------------------------------- fi Final Inspectiot� ----- - - Date ~ SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1.-'68 Rev. 5M