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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit Na �5 (Complete in Tripticatel ••••.•....•.__.._.... This Permit Expires t 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 made in compliance with Courlty Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/1.0 ATION 0._7...0.,.y..._ ,_.�-OJV_E.•... ...__... 1 ��........CENSUS TRACT .......................:.. Owner's Name .. V �--------- .. 7_. _. F• .N................................................ ...PhonepO•o,].'�--�r Address . ...,----- 30.'7OV .,�-,• dN,4------ XE- 0E_•---kd......................... CityQAr-�.Cd,�l.�_..........._. . Contractor's Name ---- .F.___.....0. ' 2-0-- ..................License # .. Phone installation will serve: Residence IR Apartment House f-] Commercial❑Trailer Court Motel ❑Other..................... Number of living units:--.-/...... Number of bedrooms ..,,..._Garbage Grinder ............ Lot Size !�f : Water Supply: Public System and name ............... Private ' d Choracter of soil too depth of 3 feet: Sond'❑ Silt❑ Clay` [3Peat❑ Sandy Loam ❑ Clay Loam ❑ Hardpan Adobe 0 Iall Material ......__It yes--type ......I........ ............ _ (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 I j Size------------------------- ,_._.._ ..... Liquid depth .. Capacity -------------------- Type-------------------- Material................ No. Compartments --.................... . j Distance to nearest: Well ....................................Foundation ...................... Prop. Line ...................... �' LEACHING LINE p�j" No. of Lines ------------------------ Length of each line-------..._•---............. Total Length 'D' Box ........-... Type Filter Material ------ -------..Depth .Filter Material ............................................ x .-Di stance-to nearest: Well ..................... Foundation Property Line ........................ -- -. _. = � SEEPAGE PIT O Depth --------•-----....._ Diameter ---------------- Number _..------...---._.......... Rock Filled Yes ❑ No �❑ Water Table Depth _---------••-- --------------•--- -•--•-•-----Rock Size ......................... ----•- Distance to nearest: Well ---------------------------------':------Foundation .................... Prop. Line ...................... REPAIR ADDITION(Prev. Sanitation hermit# .•................1._..__._ Date .................------ t�t Septic Tank (Specify Requirements) -•--------- -------__....._....�.. ................../ _a !? ._...: / / Disposal Field (Specify Requirements) __ --•- fa .... _�_...1� 1.l&e....-s—,.--.C/-------------------------------------------- ----------------- ............................ ............._.......... ...................--------------------•-•------------------------------------------ ----------- ------------•----. ---- ---------•................:_...,__...__......:::::................. .... {Draw existing and required addition on reverse side) I hereby certify that 1 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: AAI certify that in the perFormance ITrk for which this permit is issued, l'shall not employ any person in such manner as to be s;,ject to or ' sc tion taws of California." Signed ----.. Owner By ---- ------ _.... . •------ • Title ---------- {If ofihe an owner) � FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ...... .. c.__-- _- •- .. .. ......... .. .. . -------------------- DATE . .1�...1� 73� BUILDING PERMIT ISSUED -------- DATE ._.... ...__...._._.._ ......................•--...---._...------. ----- __...------.-.. ADDITIONAL COMMENTS ..................................• -- ------ - ---- ---- --- - ---------------------------------- •-----------------------------------------------------------------------...__.---------------------------•- - --------- ..................---------•- ....--•----- . -------- Z •-- Y," Final Inspection by: - ---- ,/ mss.- ----.Date -.. ._.......rx ._��:--.----- . E1 13 2h 1-68 &-v. 5m SAN JOAQUIN LOCAL HEALTH DISTRICT 8/7h 3M