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cTOR OFFICE USE: ,�•• 'APPRATION FOR SANITATION PERMIT �. - - - --- - -- ------ ° Permit No. 1-5 Z i _ c�-3(� (Complete in Triplicate) ` -------------- Date Issued �--��--�-- 7— This Permit Expires l 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 mq i co I' nce yvit County Ordinance No. 549 and existing Rules and Regulations: `fid a2/J9 G �c e� JOB ADD SS/L ATION . - ----- �--� ----- - --- SUS TRACT --•----------- ----------- t. ,� t its 1 f__. �''e `-- :_ 1lAl hone ---------------------•------------- Owner's are 1 it,.._ .5 p--------- 1.� a" Address �'?1-"Z City _ _ .. N -------- '{ 1 ----` --j I ----------------=--- License # -- -- -- one --C�--- - Contractor shame _____-�---. � ------�-- � '---- - - Installation will serve: Residence V] Apartment House❑ Commercial :❑Trailer Court ❑; ' Motel ❑Other -'-147--------------------------- t u: Number of living units:---- Number of oms - ___Garbage Grinder � _ � _~- -E_ ____ Lot Size _ i Water Supply: Public System and name ------ j Private } Character of soil to a depth of 3 feet: Sand'❑ Silt 0 Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam;❑ T Hardpan ❑ Adobe Fill MateriaVVP-_____ If yes,type ------------------------ - #. (Plot plan, showing size of lot, location of system in relation to wells, buildings, .etc. must be placed on reverse side.j k NEW INSTALLATION: (No septic tank or seepage pit permitted if �public sewer is available-within 200 feet.,).,�f�lJ * ' 4 - �7 V-5 Liquid Deptl ---//,i&-J--1'-/_-�•--=----.----- PACKAGE TREATMENT [ ] SEPTIC TANK ( 1Ze t . Q, C_�C No. Compartments '---•-•---?-----.... Capacity._ - �� Type __!_�':-- -q,��Material Distance Oto neare Well ---------S70--------------------Foundation -----)-0-r------ Prop. Line ---.`J�- -=--••---- 'Len til'of each ine f�/ otal Length�l LEACHING LINE '] No. of Lines;__-_.__ ______ ______ g j- } �j `c 'D' Box __ _-__ _-_ Type"Filter Material ___' _____.__ epth Filter Material ----- / --------- Property Line. -16----- - --- Distance to nearest: Well ____ _ __________ Foundation ____ s SEEPAGE PIT (y� ------ Depth Diameter _ __`__ Number _-__________ _..__ Rock_.,Filled Yes [ No i❑ 1' Water Table (Depth- =_== ------- 11 --•------ Rock-Size--.11- �.-- - j Y Distance to nearest: Well -------!G- - ----------------Foundation ----- _�'�=-= Prop• Line _ _..___._.----__-_ f - - REPAIR/ADDITION(Prev..Sanitation,Permit# ------------------------------ ----- Do ----------------=' �-----------1 : . , r �.-. - :_-- `. M_ .... • -� --------------------------- ---- '; --- Septic Tank {Specify Requirements) ------------------------ ------------------------------------------------------------ -„� 9 � Disposal Field (Specify. Requirements) ------------ • ------------------------------------#-------------------------------------------- • x •} :� w - -------------------- ---------------- ------------------ ,-•------------------------------- --------- ---- --- -------------- = - (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`'3am 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 Cowpensation laws of California." r - 'Owner F ____ ( / - __________________ __Signed --------- --------------------- If other than ow f FOR .DEPARTMENT USE ONLY APPLICATION ACCEPTED BY - -- --------- ---- DATE = r - ------------- BUILDING PERMIT ISSUED -- --------------------------------------------------------------- DATE ADDITIONALCOMMENTS --------•---------------------------------------------------------------- ----------------------------- ----- ------ ---------------------------- ------------------------------------------------------------------------------------- - ------------ - �----mac -- -- - ---- -- - ------ - -- - -- : -------------- ------------- ------ -_- . Final Inspection by: -' Date ------- ------- -------- si - - ----------------------------- - SAN JOAQUIN LOCAL HEALTH DISTRICT " E.:H:9 1-'68 Rev. 5M. <. ;, •i_ ? R .. ! # l:�