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_ FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ------------------- --------------•-------------- Permit No. Jti (Complete in Triplicate) " = ' ` Date Issued ------ --------------------------_ This Permit Expires 1 Year From Date Issued Application,is hereby made to the San Joaquin Local Health District for a permit to,'construct and install the work herein described. TFlis application is made in compliance-with C ur-ty Ordinance No. 549 and existing Rules and Regul ions! JOB ADDRESS/LOCATION _52., l-► - ---`--------------------`.------..CENSUS TRACT --------------9--1- ---- ------4a>PF--- R ---------- 4--- --- ---- n 2 -67 Owner's Name R��.N --- ------- Phone t? 7.. l a -g�`' �`�------(T city Address ------ Contractor's Na me ----�41�'t -------- -------- ------------------�/--------.License # ---- --- #---------- Phone --------------------------- Installation will serve: Residence ❑Apartment House.❑;Commercial. ❑TraileryGe4i* 't Motel E-] Other ---------------- -'� '- - Number of living units: ...I--- NO mber of bedrooms -. - farbage Grinder NQ__ Lot Size -. --------_____ Water Supply:.PubliciSystem and name ----------------------------- -- ----------------------------------------- ------------------ Private i. ld p ❑ .. 3 r y ❑ Peat_T .4,Sandy-Loaf- � Clay_Loara ❑.. :.._..- c Character.of-soy! to a e th of 3 feet:-:-5and' Silt.. _ . Clay lY , R e ---- r Hardpan ❑ Ado FII Material _ f1___ If es, { �'] Y tyP ---------------------------- P (Plot plan, sowing size df lot, location of system in relation to wells, buildings, etc. must be placed Ron reverse side.) NEW INSTALLATION: (Na- septi!tank or seepage pit permitted if public sewer is available within 200 feet,) r� . PACKAGE TREATMENT { ] 5EPTICTANK f Size-- ---------------------------- •- ------E-- Liquid:Depth�_____/___--..- :- t, i�ry ', � Capa �tyc3--D _____.,__ TypeiRXMaterial: _-�•- No. Compartments __ -__. ------------ ` Dista rice to nearest: W fl ___---_--______�t�___ Foundation ________. _____ Prop. ---- Lin _______`. ___:..::_. LEACHING LINE � o. of Lines ---------�.- ----- Length of each line-__-_------�,q V-1 Total Length ____��Q__. t ; qqtr l `'Box Q Typ (Filter Material ------ D' CJ��,.-_Depth Filter' Material ___[--L-- -----------------------------':� (� ' I l _-_ Property Line - Distance #o nearest::Well _.______-�©____ Foundation ----------- --- -- p ty .i SEEPAGE PIT [ ] Depth Diameter Number ________________ _.____ -__ Rock Filled Yes ❑ No 0 ,' ' Wate 5, Table Depth.---.-.------------------------- .—Rock Size—-='--------- ----------------- Distance to nearest: Well _.______. ------- -_.-....-Foundation ------t------.---- Prop. Line ______________________ n REPAIR/ADDITION(Prev. Sanitation Permit i`.,=------------------------------------------- Date ------.------`------- -••----------) : Septic Tank�[Spe cify iR q # .. .. _. -- { i Disposal-Field (Spe'i'fy Requirements) ---------------------------------------------------------------'' ---- ------------------------7- -------------- l ------------------ -- - --- ------ ---- —_ ------ ---------- -- ----------- - ? - --- f4 {Draw existing and required addition on reverse'side]uj ; I hereby certify ththave prepared rhrs applicarron and that rhe work will be done in accordance with $an .loaquin County Ordincinces,,;State Laws, and Rules and Regulations of the San Joaquin Locale Irlealth District. Nome'owner or licen- sed agents signature-certifies the following: i l E "1 certify that in the.performance of the work for which this permit is issued, I shall nl r employ any person in such manner as to become sub]ect to Workman's Compensation laws of California." } ( E Signed - ' ----- ------------------------- Owner --- BYr-------------- (I !'` - Title _; ' { �3 (If otherxhart owner). FOR DEPA MENT USE ONLY( ' # APPLICATION ACCEPTED BY -----F f_X0-----------I-------------------------------------- ------------------ -------- DATE BUILDING PERMIT ISSUED --1--D- ATE -------- ------------------ ADDITIONAL COMMENTS -_ _ _ --------------- ---- --_-_'-`-----------•--------------*.:----------------------- --------- ,' - _ ----- ----------- ------- ------ - - -- -- -- --------------•-- ---------------------------------- --------------- ---------- ------------- ---- -- - ---------------------------- Final Inspec i Date SAN JOAQUIN LOCAL HEALTH DISTRICT ` E. H. 9 1-'68 Rev. 5M.