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f ' FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit Na --------------- -------------- - ------------ (Complete in Triplicate) -- --- -------------------- ------------- p - Date Issued-3--_--2/---6- This Permit Expires 1 Year From Date Issued Application is hereby N, ejto 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 Rul9s 11and Regulations: • _. �.. �.. I JOB ADDRESS/LO TION C -' r ~ ' °gID. ` G"_� CENSUS TRACT -- ---- -------------- o . ------ _. Phone "J ' Owner's Name �- -------- ---- �/��[ ----?-------- ----------��-;:-;------------------------------ Address s, y �� I - .J2..::= - Cit �3 S ^fes -- Contractor's Name _._.License # Phone - . Installation will serve: Residence V-4partment House❑ Commercial Trailer Curt ',E] Motel ❑ Other ____._ -I AA �.=Garba +� L� .lI% ------- --------------- Number of living units:--- Number of bedrooms.____ ge Grinder _�':___-;;Lot Size __�_.-.-� I i --3-------Private Water Supply: Public System and name ________________________ -___. .___ __ - - Character of soil to a depth of 3 feet: Sand'❑ "Silt n "`'Clay ❑ Peat ❑ Saridy"'Loam ❑ Clay Loam ❑ Hardpan ' Adobe ❑ Fill Materialf-I--___ If yes, type --------------L---._________- Ian showing size of lot, location of system in relation to well s;'bu dings, etc. must be placed on reverse side.) k (Plot p 9 Sr i[ NEW INSTALLATION:, (No septic tank or seepage pit permitted-if public sewer is available within 200 feet,l �e PACKAGE TREATMENT [ ] SEPTIC TANK-�K Sze----- d 1f f------------------- Liquid Depth __.- _ ------- Capacity1:451 T e ----------------- Materiall0400_ �= No. Compartments --�___-_____------ �1 r YP ,---- istance to nearest:�'Well ---- - Foundation __/0------------- Prop. Line ___3-----_-----.-.--- ----- -- --- Total Len "I LEACHING LINE [ l No. of Lines..�''Ad _--- ----- -- Length of ac�line_____5 ---------- - gth `.RP jj 'D' Box '/. ____ Type Filter M}a�fieyrial L ___`-__Depth Filter Material __.-1.__I--------------------------------•- Distance to nearest: Well ----- Y------------- Foundation ___----/0_____---- Property (Line _._ _-___...----- s ;g ,tI SEEPAGE PIT Depth _�Y______________ Diameter - _______ Number -_-�-----------.___ � Rock Filled Yes 1[" No f Water Table Depth _._. ro ---Rock Size ___�-------------------=---I -------------------------------- I I Distance to nearest: Well .ld_�_---------------------------Foundation ___.� __--____-- Prop. Line __..._ _____....._. REPAIR/ADDITION(Prev. Sanitation Permit# -------- ----------------------------------- Date -----------------------.----------) Septic Tank (Specify Requirements) ------------ -------' -- --- ---------- P--,------------------------------------------ ' ...----------- - - Field (Specify Requirements) .__ _:_ ------------------------------------------------ Disposal ' __ _ c. _. 5 r=- k ___________ _______________________________________________ __ _ --------------------------------- _____________________________________________________________________________ -_________----__._________------_________. _ --_.__-______, . ;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 shall not employ any person in such manner as to beco sub'ect to Workman's Compensation laws of California." Signed -X'-- "{ 1 Title -'--� 1 t7 f Owner I By - E C.< ----- ---------------- (If other than o ed i FOR DEPARTMENT USE ONLY 2 APPLICATION ACCEPTED BY 1 '! �p---------- 3- 7T- APPLICATION --------------------------. DATE ------�J ----� = if PERMIT ISSUED --- ----------------------- -----------DATE ------------- ---------- ---------------- ---- --- '--------------- --------"-- -------------------- ADDITIONAL COMMENTS -- -- ---------------- ------ ------ --- --------------- ---- ---- - ------- ---- -- ----- ---------- ------ ----------------------------------------------------- ----------------------------------- !_ Final Inspection b Date -__--- ---- -j. - SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M