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fi012 OFFICE USE: AP CATION FOR SANITATION PERMIT I �- �a - -------------- �., (Complete in Triplicate) --------._ Zq – V3� 3 -------- ------�- - -- D to Issued -�--=-30--7!_-.. This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to st c an in ll� work herein described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION M 4CO_r-d------ &-e--------------------------------------CENSUS TRACT --------`------------------ Owner's N e _ ._6:7_Q_ d r_S1` �� % G4'fi --.._.Phone Addresss.�. ------�C3-S" ----------------------------------------------- city --------------------------------------------- Contractor's Name ----------------------------------------------------------------------------------------License # -----------------_---. Phone -----------------------_-•- Installation will serve: Residence ❑ Apartment House,Dd Commercial ❑Trailer Court ;0 Motel ❑ Other -------------------------------------------- Number of living units------ ---- Number of bedrooms -_.3_____Garbage Grinder -------- --- Lot Size -------------------------------------------- Water _______________--_Water Supply: Public System and name ---------------------------------•-----------------------------------------------------------------------------Private 91 Character of soil to a depth of 3 feet: Sand'[] Silt,E] Clay ❑ Peat%. Sandy Loam ❑ Clay Loam ❑ Hardpan ❑ Adobe ❑ Fill Material ------------ If yes, type ---------------------------- (Plot _______________________(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 flank or seepage pit permitted if ublic sewer is available within 200 feet,J PACKAGE TREATMENT SEPTI//C TANK'[ ] Size------- ____________G3!Y __ Liquid Depth - _=_�_ ___________. Capacity Lo do _l Type -------------------- Material794'00_44 No. Compartments -�----•--- Distance to nearest: Well ------- -----------Foundation ___16W,0 v`.£_ Prop. Line eV LEACHING � e6 INENo. of Lines ______.__./----------- Length of each line.___----_ - �___-__-.-_ Total Length Type D' Box p -____T//.-_............. 7 e Filter Materials _AI�_� _ _De th Filter Material ________JLhl.��/1 ______ ....... �'�' �r Distance to nearest: Well _/"- _________ Foundation y�li�` 1rr ____ Property Line SEEPAGE PIT [ ] Depth ____________________ Diameter _______________ Number .__________-_._____- ❑---____ Rock Filled Yes No ❑ Water Table Depth -------------------------- ---------------------Rock Size -------------------------------- ' Distance to nearest: Well ________________________________________Foundation --------------- -___ Prop. Line ____-___.._-__---_._ REPAIR/ADDITION(Prev. Sanitation Permit# _-__---_.____ Date _______________ �� ---------------/------------------ -- 1-51i3' Septic Tank (Specify Requirements) - --tlllr..�h?_v� 6�__�'C_� �J_'fill•5��!/ -Qr- -- - -U�S =--• ,�!% oda- �G�f ° a, � -�_.��-- Disposal Field (rSpecify Requirements) _�_ __ __ �- lhJ C/i __!yal ` 1 ---�� --------- -------------- ----------- ------------------------------ ------------------------------------------------------------------------------------------------------------------------- (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 become subject to Workman's Compensation laws of California." Signed - ------ - - Owner BY - 1 Title . _. x�=�.. (If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ------ ---------------------------- DATE �,3Q-may BUILDINGPERMIT ISSUED --------------------------------------------------------------------------------------------------------DATE ------------------------------------------- ADDITIONALCOMMENTS ----------------------------------------------------------------------------------------------- -------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ----- ------------------------- --- -------- T� ------ - ------------- ----- ------------------------------ Q- ,r/ _ - Final Inspection by: Date � ' 'r7 --- .�� -W. `'vim N(�N AL HEALTH I R 7� �� E. H. 9 1-'68 Rev. 5M