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F T _Z "_22)O FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT permit No. _ Z ---------- (Complete in,Triplicate) - ---------=--------------- ------------------------------- C�__-7z ----------------------------------------------------------- Date Issued This Permit Expires 1 Year From Date Issued _ f Application is hereby made to the an oaquin 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: JOB ADDRESS/LOCATIONP 1f��_ -------CENSUS TRACT Owner's Name .__ f4-/ 1 [ Q/----------------------------------------------------- -------------------Phone . Address - City ------------- ----- Contractor's Name --- kIEZY ------� --------------------------------License #17.7,1—3--- Phone _4��:.5.02 _ Installation will serve: Residence KApartment House❑ Commercial[]Trailer Court ❑ � Motel ❑Other.-=------------------------------------------ n Number of living units:_______ __ Number of bedrooms __________Garbage Grinder IVP Lot Size ------------ Water Supply: Public System and name ----------------------•-------------------------------------------------------------------------------------- Private Character of soil to a depth of 3 feet Sand'E] Silt j] Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam.E] r Hardpan ❑ Adobe Fill Material - ---------- If yes, type ______________-----_-----_- (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,) i A .� PACKAGE TREATMENT Ca acEPTIC TANK, Size_:_ ,; ,<l� -------------------- Liquid Depth _ _.-....__----_------ � { ]p y ,_ Type�Ga, r _' Materiail ; No. Compartments _ .�_____________ Distance to nearest. Well -- ----------------------Foundation -/Q-------------- Prop. Line _✓5------------•------ �J S LEACHING LINE (J No. of Lines ------l.___________- Length of each line-___/1V0 f_____.__-___ Total Length ___1G '______________ - - 'D' BoxA//. --_- Type Filter Material) i, /�-'_---Depth Filter.,Material --------------------------------- Distance to nearest: Well ---- -- ------ Foundation ____l_0_____________ Property Line 4 SEEPAGE PIT Depth 112(-T------------------- Diameter -------- Number -----./------------------ Rock Filled Yes Z No fl Water Table Depth � * ---------------------- ----------Rock Size _ 141_1f--------------- I � Distance to nearest: Well _.___,1�j1------------------------Foundation __��._�________ Prop. Line _.s,��....._... - i REPAIR/ADDITION(Prev. Sanitation Permit S# --------"----------------------------------- Date ----------------------.-----------) I Septic Tank (Specify Requirements) ------ - ----- -- --------------------------------- -----------------------------� --------------------------- - --------------------------- i DisposalUField (Specify Requirements) --------------------------------------------------------=---------------------------------------------------------------------------- ------------------------------------------------------- ,}------------------------------------------------------------------------•---------------------------------------------=------------------------ ------------------------------------------------------------------- --------- I hereby certify that 1 haveprepared(Draw existing and required addition on reverse side) y y 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. Horne 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 become subject to Workman's Compensation laws of California." , Signed ------------------ ---------- -- ------- --------------------------- -- ------ Owner # 7Title..---C1--�-�-� By ------------------ -----------F---- " ------- - -- ---- --------------- ------------------ (if other,Van o er FOR .DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ----------- -- - ----- ------ --------------------------------------------- DATE __` �`L�._ 7 ------------- " BUILDINGPERMIT ISSUED ---------- ------- -- -------------------------------- -------DATE ------------- ----------------------------- ADDITIONALCOMMENTS ------------------------------------------------------•---------------------------------------------------------- --------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------ ------------------------------- ----- ---- ---- -- - - -------- -------- --- -r - ............ ------------- ------------------------------------------ --- ti----------------- r Final Inspection by - ---- - ----- .. ---- --Date --- i � SAN JOAQUIN LO AL EALTH. DISTRICT E. H. 9 1-'68 Rev. 5M �