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FOR OFFICE USE ------- +---------------------------��'3 a APPLICATION FOR SANITATION PERMIT -- (Complete in Triplicate) Permit No. ._7y1._"f!�W, ---------------------------------------- This Permit Expires 1 Year From Date Issued Date 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. 49 and existing Rules and Regulations: JOB ADDRESSAOCATION Z-� �. 2 C Owner's Name -"_�� _ -" ENSUS TRACT ---------------------------------------------------------Phone -------------------------- --------- ---- -------------------- --------- Address ?"leaf__ ---- -- - Cit Contractor's Name _ � ^�^ " •-•-•-•-- . ..� Installation will serve: Residence APartmentFle❑ Commercalse #x1173_ Phane Q._3 ❑ Court ;❑ Number of living units:___ Motel El Other ------ ------------------------------------ ______ Number of edrooms Z. ___.Garbage Grinder ------------ Lot Size -.4�47_X____1470 Water Supply; Public System and name _-_ _ _Y/-� ___Private ❑C aracter of soil to a depth of 3 feet: Sand'❑ St[f"' 1a ❑ peat Sand Loam ❑ Clay Loam.[] Hardpan Adobe, Fill Materia If yes, type___-__ ---_--_ _---_--- W (Plot plan, showing size of lot, location of system--in—relation to welts, buildings, etc, must be placed on reverse side.) NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer�s av iIbfle w thin PACKAGE TREATMENT 200 feet,} [ ] SEPTIC TANK� I r [ ]3 Size : -- --- ----- A Liquid Depth -------------------------- t.,JA-1Capacity -- ---------- Tie ------------------- lfllaferial------- ----- l r Compartments --------------------- Distance to nearest: Well --------- *_ _- � �a�� -,---!--- ----- Prop. dine --------•--- ------ - LEACHING,LINE - C 1 No. of Lines _ --- -----_"---__ Length of ech line-___ J----- " 0- Total Length __ ------------------ A " - &/K r$r�ci 'D' Box _ Type Filter Material j_ _ Ma `f Depth Filter Materia!° __ #__"" S Distance to nearest: Well _. �zs .. __ Foundation_ t �?` SEEPAGE PIT r - _-- PropertyLine --•---"_"--- [ ] Depth ---- --__ Diameter ----------- --- __ Rock Filled Yes No Diameter -4 = Nu�ber Water Table Depth _ ' (f- -------- Rock�Size _ � X f Distance to nearest: Well _ �src. Foundafi�on�- __ --.Prop: Line _.- REPAIR/ADDITION(Prev. Sanitation Permit# _______-._-_._ _- """_-""-_ r Date ------------- Septic Tank (Specify Requirements) --------------- --------------- --------- ' -------------------------------- - ----------------•- Disposal Field (Specify Requirements) �' �� "-"- x ------- _ ----------------- --------------- --------------- ------- -- [Draw existing and required addition on reverse side) I hereby certify that I have prepared thisc�pplication,•and that-the work will-.be done in accordance with San Joaquin County Ordinances, State Laws, and Rules and Regu!•aatlons ofj th San�Joaquin LoccIHealth District. Nome owner or licen- sed agents signature certifies the following: "I certify that int erformance of the work for which this permit is issued, I shall not employ any person in such manner as to become O!Vf to W km '�Compe sati.on laws of California." Signed ---------- -- - _-"-- Owner BY --- (if --ac. e at -- caner) _ Title - --- -- Y FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY __ 4�nn_ . ._ BUILDING PERMIT ISSUED ___ -" -------------------------------------------------- DATE ------------------- ZONAL COMMENTS ----- ---------------------DATE ---- ------------------------- - - - -- ---- ----------------------- --- -- -- , --------------------------------------------------------------------- ----- ------------------------- FinalIns ection b ----------------------------------- ------------------- ------------------- - -- - -- - ---- -------------------------- ----------- Date --- - -- - ;�.- ------- ---------- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M