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x FOR OFFICE USE: APPLICATION FOR SANITATION PERMITS --------------------------------------------------- Permit No,. u ----- (Complete in Triplicate) - ... ---------I-------- ------- - 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. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: s lL'z' --- ------------------CENSUS TRACT --------------•----------- JOB ADDRESS/LOCATIOrN,.__'_._L--T��--,.1-�±-`--- --- - ---�- ,.y Owner's Name --- --- (s�--� p -----------------Phone ---477--1__ ��-- AddressQ -�---- : -------------- Ci tY - n'' Contractor's Name --.-------co__--------- --- ------------------ - License # 97'37--7-1- __ Phone _417-7=--7,6'V.f Installation will serve: Residence ❑ Apartment House❑ Commercial ❑Trailer Court i Motel ❑ Other Number,of living units:� __ Number of bedrooms -----'_.___G� ar Grinder ------------ Lot Size ------__A_fJ_ __ _______________________ Water Supply: Public System and name ---------------------------------------------------------------------•------------------------------ ---------Private ;s F Character of soil to a depth of 3 feet. Sand'❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam �I Hardpan ❑ Adobe Fill Material ------------- If yes,type _________ __________________ a (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 0 Size___ _____ __ _ ________ Liquid Depth -- ------r r��`�__ No. Compartments ' d Capacity .r 2-©Za---- TYPe It Mafierial_ r Distance to nearest: Well ______ __________________________Foundation ----------d_________ Prop. Line --- ----------- ...... LEACHING LINE No. of Lines ------I----------------- Length of each line.__ C _.__------ -- Total Len th .____` '. .__.___.___. 'D' Box ____/_-----_Type„Filter Materiae- �.tDepth. Filter Material ___�_ _______________________________ �.... - r w Distance toLnearest: Well_=f _t�_�____-_ Founion/o._----________ Property Line -------------- I f .�.n � SEEPAGE PIT Dei3th - -_ Diameter ,414 ___ Number ______ --------------- Rock Filled Yes No 0U”. R II I r ! !- �� 4' � C`a � )`?: ,. --Rock Size �yx Water Table Depth :.. T Distance to nearest;,WelI _ _' _ _-_____�______---Foundation Z-0...__---- Prop. Line -------------- ....... REPAIR/ADDITION(Prev. + -� o�. { Sanitatin Permit# ------_ ----------:-------_--`--- D to ? Septic Tank (Specify Requirements) ,.. ; ,, Disposal Field (Specify Requirements] T:::::-------------- -- �----- ---------------- ----- -- ------------------------J _...z- i� b r I herebycertify that I have prepared this application and ,that !h -- -- e ^ € (Draw existing and required addition on reverse side] y e 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 o an s Compensation laws of California."qq�� Signed ------lJ<.� -- ------- --------- ------------- ---- -------- 'evmeT BY ----------------------------------=--------------- ---- =- ------------ -- -- ----- -- Title (If other than owner) FOR DEPA TME USE ONLY APPLICATION ACCEPTED ,�oo-'-_ L BY ------�•�•_ -- - ---------- --��_ - ------------. DATE BUILDING PERMIT ISSUED ---------------------------- ----------- ---------------DATE ---------- ------------------------------•- ADDITIONAL COMMENTS ----------------- -- --------------------- --------------?---------- ------------------ ---------------------------------------- --------------------------------------------------------------------------------- ---------------------W---------- ----------------- -- - -- -- - ------------ --------------------------------------------------------------------------------------------------------------------- -------------------------------------------- ------ Final Inspection by -------------------------------------------- ==------------------------------- Date SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M