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FOR OFFICE USE: x- APPLICATION FOR SANITATION PERMIT F ----------------------------------- Permit No. {Complete in Triplicate} k This Permit Expires ] Year From Date Issued -----------------------------------------___-_-_--_---___ Date Issued :�I-_ _`!. Application is hereby made to the San Joaquin Local Health District for a per to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: 7E _ --- , JOB ADDRESS/LOCATION .---/S�� -- ��11JJL�TR - ------ .�7=------------------------CENSUS.TRACT --s--_-- -'---------- Owner's Name ------W'-----LAVE .TO ----------------------------------------------- ----------Ph ne QQ Address --------- ----------- --------� 1 T =-------. city SC } Q/ -�`-_---_-�p '- Contractor's Name --- --, ---_ Ral -=-------------------------------------License # 29-1 --- Phone Installation will serve: Residence [] Apartment Ho'us'e''❑Commercial"❑Trailer Court � I � Mote! 13 Number, of. living units:-._ '___ Number of bedrooms "--�..__GarbageGr`inder - �___ Lot Size ..s_I�GREJta ...-_------ = -� Water Supply. �blic.Systerm}c�nd narrae = ---------------------- ----- ------------------------------ _:Pnvate_ j -,g and ..._ I Charact�erVoflsoil fio a_depth'of.:3 f t � ; j,- =t• -( Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam.H' Hardpan ®—Adobe ❑ Fill ltillafe�ial if yes, type ____................::_ - -. (Plot plan, showing size of lot, location of system in relation to wells,lbuildings, etc. must be placed on-reverse side.) NEW INSTALLATION: (No septic tank or seepage pit permitted ifpublicsewer is available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK [ Size----7___�/0_.X.S-------------------- Liquid Depth ._. ! --,__._ Capacity _/ZoCO____ Type f R_-ET7)9_I3_ Material-C01\1.0------ No. Compartments ..--..�� _..._. r `J — 4 Distance to nearest: Well ---------------- ._.. ........Foundation _2zS-.-�._..---__. Prop. Line ---'>----- y LEACHING LINE [or�No. of Line's -------f............. Length of each line----- ----------------- Total Length ...__--t --------------- 'D' Box lY-�_-. Type Filter Material L - Depth Filter; Material -------- - t,Distance to�neorest: Vllell, J__.t-- Foundation _.�D----�..--- Property Line .s.._. -__.-__. ;a I SEEPAGE PIT [� Depth _frZ_.._---_.__ Diameter - - --- Number -------/---___._.-_----- Rock Filled Yes No 0 + .� Water Table Depth �-r------------- ,Rock Size 2/:2z-- - , Distance too nearest: Well _----.�09 f...............Foundation .1 .... ---- Prop. Line S.._-- -._._---. = + REPAIR/ADDITION(Prev. Sanitation 'Permit# -------- ----------------------------------- Date ----------------------------------) Septic Tank (Specify Require - Requirements) ------------------- -------------------------------------�------------------------------------- --------- .< --------------- DisposalField (specify Requirementst ) ---------------------------•----------------------------------------------------------------------------------------- --------------- �.. i ,VV i ------------------------- `---------- ---------------------------------------------------------------- - ------------------------------------------"--------------'------------------------------------------------------------------------------------------------------------------------------------*-----�`'---- _ ""Draw existing and required addition o� reverse side) Y - 1 hereby certify that 1 have prepared this application and that the work will be done in accordance with "n-Joaquin County Ordinances, State Laws, and Rules and Regulations of the. San ,Joaquin Local Health District. Horne owner or licen- sed agents signature certifies the following: "I certify that in the performan a of the work fo which this permit is issued, I shall not employ any person in such manner as to beco ubj - to Wor n'siCompenSat'. n laws of California." F� F Signed ------------------- Owner BY ----------------------- ------------ - ------ ---------------------------- Title t (If other than owner) FOR DEPARTMENT USE ONLY - _ APPLICATION ACCEPTED BY ------- �- — - -_- - ---------------- ---_--- DATE ��.-- - BUILDING PERMIT ISSUED------ ----- -------------------- -t- --------------DATE -------------------------------- ---------- ADDITIONAL COMMENTS -------------------------------------------------------------------------------- ------------------ --------------- --------- --------------------------------- -- ---- --- ---- -- = ------ ---- ----------------- ----------------- ----------------------- Final Inspe b = _ -------------Date ---�,` SAN JOAQUIN LOCAL HEALTH DISTRICT y 1 E. H. 9 -1-'68 Rev:5M 1 I