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FOR OFFICE USE: ,2- APPLICATION FOR SANITATICkN—PEP.MIT ---------- ------- -----•--------------------- F �. .� Permit No. (Complete in Triplicate) _________________________________________________________ This Permit Expires 1 Year From Date Issued Date Issued --. ----- --(p� Application is hereby made to the San Joaquin 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 an existing Rules and Regulations: JOB ADDRESS/LOCATION ---_ -__--Crwp��_..4 __. .___.t-CENSUS TRACT Owner's Name J7 ------- < ---------------------------------------------- ------------ -----Phone ----------------------------------- Address ----------- © � �C� Ccz�z-c� �` City -,-.r- �"'------------------------------------------- Contractor's Name --------- �-------------/�� --------------------------------------License # la 5_` }z- Phone _ l.T 1 Installation will serve: Residenceartment House❑ Commercial .❑Trailer Court ;❑ Motel ❑Other --------------------- -------------- Number of living units- ---I---- Number of bedrooms --------Garbage Grinder -L---------- Lot Size --------. ............. Water Supply: Public System and name ------------------------------------/-------------------------------------------------------I——------------Private a' Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat❑ Sandy Loam -❑ Clay Loam ❑ Hardpan ❑ Adobe V Fill MaterialIf yes,type ---------------------------- JPlot 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,) ,` f PACKAGE TREATMENT { ] SEPTIC TANK'vT Size.--------_- -------------------- Liquid Depth -----_-- --__- Capacity -1_i[1 ----_---- Type 04e-LASrMaterial--.- 4s,_G o. {Compartments -_ -------------- �1 Distance to nearest: Well -------15^ 15---------------------FoLmdation ----------- Prop. Line -_*-+---------.___-__ LEACHING LINE No. of Lines g . 1r �], Length--_-- Length ofreach line�_,_¢_�_ _ _____ ___ _ _____ _ Total LentG th ��..-__._-_.__-._--._.__ 'D' Box lf,&__ Type Filter Material _ �,"- -� -"Depth Filter Material -1a--. 1----------------- ------------mss, 1 Distance nearest: Well _:� _-_--______ Foundation �L.-e -_--------_ Property Line .44.............. tl _SEEPAGE PIT [{�/1 Depth n.-__ Dia//m��eter „._,7_______ Number __ _ _.T___-_ Rock Filled Yes 5� No �❑_ Water Table Depth -_--_-f __l- --_-_ - Rock Size _1_------��---.____ - ------------------ - Distance to nearest. Well ----J-DfJ--------___--;�_ _Foundation _54----------- Prop. Line - _______________ E REPAIR/ADDITION(Prev. Sanitation Permit# -----_-------------------------------------- Date'-___.-..--___--I------------------ Septic _Septic Tank (Specify Requirements) ----------------------------------------------------------------------------- f ------ Disposal f=ield JSpecify' Requirements) -----------v-- ------------------------------- -------------------------------------------------------------------------- ----------- ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ------------------------------------ --------------- ---------- ----------------------------------------------------------------------------------------------------------------------- (Draw existing and required addition on reverse side) I hereby certify that-, 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 ------- ------------ ------------------------------ ---- ;title .------ - - -------------- (I -of er than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY DATE -- -- •-- BUILDING PERMIT ISSUED - ------------- -------------------- ---------------------------------DATE ------------------------------------------- ADDITIONALCOMMENTS -------------------------------------- -------- -- -------- ----------------------------- -------------------------------- ----- --------------------------- -------------------------------------- ----------- ------------------------ ------------------------------ ---------------------------------- -------------- --------------------------------- -- -- -- -- -------- ---------------------------------------------------- -------------------- R Date Inspection by: -----•------ SAN JOAQUIN LOCAL HEALTH DISTRICT' ' E. H. 9 1-'68 Rev. 5M r