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FOR OFFICF� U E: r� -� APPLICATION FOR SANITATION PERMIT -----------�--;4-_---f.')-ic_ Permit No: 7C- , {Complete in Triplicate) ------ ------------------------------------------------------ This Permit Expires 1 Year From Date Issued Date Issued Application is hereby made to the San Joaquin Local Health District for a per to construct and install the work Herein 1 described. This application is made,in compliange with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION __ !- ----------------- ---------- --------- ---- N US TRACT -------------------------- r Owner's Name ap_4 ---- ---- - .- - .--- Phone _� '�'__�6 ...-_...... 4 --- Address � "ted Y ----------------- -------------------- City �' gy�pp__ ---------------------------------------------- Contractor's - -- - Contractor's Name _t .Pet_ .J ,~ a.1 ---------------__-------_License # 6;Zs tZ�3------ Phone ------ Installation will serve: Residence ❑ Apartment House�Q Commercial:❑Trailer Court i❑ Motel`Other ' ' 0 _ 11 Number of living units:____________ Number of bedrooms ____________Garbage Grinder ------------ Lot Size -f _ _______________________' Water Supply: Public System and name ----------------------•--------------------- ----------------------------------------------------------------Private) Character of soil to a depth of 3 feet: f 5and'[]'""Silt❑ Clay`❑' `Peat❑ Sandy Laam Clay Loam ❑ 4. Hardpan F] Adobe E] Fill Material _-_________ If yes, type ---------------------------- Q (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 Size��X_ 'X;1�`_`__='____________ Liquid Depth --- ---------r________: i Capacity-0 Type '_ Material____` '_ --- No. Compartments --- Distance to nearest: Well 1J7)-----------------------Foundation -1-Q_-------___,Prop. Line __ r�,.c_ LEACHING LINE No. of Lines _______ _ ___`______ x _ Lengthlof each line---/- ---------- Total Length -- _-•'.-__-•- 'D' Box _ _.__ Type Filter-Maferialri �_Depth Filter Material -----/__rJ_____________ _ 1 Distance to nearest. Wsll.*/4V---__t___ Foundation 1/40-�- ------------ Property Line-4�F- w��... f 1 SEEPAGE PIT Depth C76.---------- Diameter _L!rr- ------ Number _____________ Rock Filled Ye No (I Water Table Depth -3-.S-------------r ------------------Rock Size- -------------- Distance to nearest: Well __________ ________________Foundation- Prop. Line REPAIR/ADDITION(Prev. Sanitation Permit# --__---- _-_ Date ____________+-- ------ ------- ap - 7' r� Septic Tank {Specify Requirements)' ` _ .� - - 2� -•- 4! � - Disposal Field,-(Specify Requirements) ,: - _�? a fe ��y��¢�'J ------- ------ - ---- i, _ f~ � _______________________________ _ ______________________________________________________________________________________________.____-_____-_________.________________________ _..____-_______________ ---------_. _ -- - _ _______________-_____-_-_________________-_________-_________________________________________________-________________________________ k(Draw existing-and required addition on reverse side) Ff I hereby, -certify that I =have prepared this application and That the work will be done in accordance with San Joaquin County QFdinance°s, State Laws, and. Rules and Regulations of the.San Joaquin Local Health District. Home owner or licen- sed agenfs.sigriature certifies the following:; "I certify fhatfn the performanc 5 # the work forwhichthis permit is issued, I shall not employ any person in such manner \ ' as to bnteLsu jectn o�orkm n's Compos � n laws of California." Signed _---- --- ' ---- - -----------<------ -- --- --- ---------------------------- Owner BY -------=- ---`-------------a,------- ----- Title ------- --- ------------------------------- [If other than o nerl il FOR,.DEPARTMENT USE ONLY ! APPLICATION" ACCEPTED BY - -,e,#- - ---------------------•----------------------------- --- DATE BUILDING PERMIT ISSUED i DATE oalr --------------------- ( ----------------------------------------- ADDITIONAL COMMENTS - -----��-�-- ��-�----- ---- -- ----- -� -- �'a--��--- D_�'l�, - ----- -- ------ �- �i� I. .,_ . f' --= - ---- -------------------------------------- --- -- - ---- - -- --------- ---- ------------------------------------ ' -- - - ------------------- Final Inspection b Date `- p Y = tl ------- ------------------------------- ------------------------------------------ �U SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M