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FOR OFFICE USE: 6 APPLICATION FOR SANITATION PERMIT --------------------- Permit No. -4 - --i 7 (Complete in Triplicate) ---------------------------------------------------- This Permit Expires 1 Year From Date Issued Date Issued1 -r___-__- .� 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: JOB ADDRESS/LO AT ON _ - �h� -:----CENSUS TRACT -------------------------- • �� sa6 -------------------- Owner's Name __011---------- ----------------------------------------------------------------- ------ ---Phone ------------------------------------ Address _. 4f- !1,P-1s -----•- Ci Contractor's Name - _( -'___ ____.License# -�.- Installation will serve: Residence Apartment House�❑ Commercial ❑Trailer Court .. r � A I Motel ❑Other --------/---------------�-------------- Number of living units:_-_- '-_ Number of bedrooms ___3/------ Grinder_�------- Lot Size --------------------------------- Water -`'�- --____..._ Water Supply: Public System and name ------------------` = - - �� ------Private Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Cllyy Loam❑ y ,, Hardpan ❑ Adobe Fill Material')---__ If yes, type ____________________________ (Plot planrshowing sizejof lot, location of system in relation to wells, buildings, etc. must be placed n reverse.side.) � . , NEW INSTALLATION: ,(No-septic.tank or es epage pit permitted if public sewer is available within 200 feet,) !..- / X(G/ PACKAGE TREATMENT {.] SEPTIC TANK Size__ _____________ _ ___ _ Liquid Depth ------- ._______`__._...- Cq. p Y/ !qO� TYp04 Lid) 'r----- No. Compartments ------ acit Material p ;i 1 • . i 5� Foundation - .__ ' Distance to-nearest: Well --��----------------------- • D------------ Prop..,Line -----••- ------------ � LEACHING LINE [ICK No�of Lines__-' -�----�- Length of each line -' -_11_-�Pd!Total-Le gth _-�.�8_�.......__ D"gox _ .�-- Type Filter Material __ L- ______Depth FiltereMaternal ___/S---___.-_____!__ .. .... ' Distance to nearest:.Well- _0______________ Foundation ------------ Property Line _�5___---_-__.__._____ : [ l p - ---meter ---------------- Number -----------------------_ Rock Filled Yes ❑ No .0 SEEPAGE PET Depth�_________________ ---met -------------Rock Size ----- `------------------------- f. , Water Table Depth --------------- Distance to nearest: Well ---------------------------.------------Foundation ---------------.---- Prop. Line ..-.------------.----- ' REPAIR/ADDITION(Prev. Sanitation P. ermit# -------------------------------------------- Date--------------------------------------I.,----------------------------------1 I 3 p p Y q ------------------------------- -------------------------------------------- ----------------------._..... Septic Tank S ecif Re uirements} _____________________________ � t DisposalField (Specify Require encs) .--- -------------- ------------------------------------------------------------ --------------------------------------------------- ----------------------------------------------------- ------------- ------------------------- ------- ---------------------------------------- I hereby certify that I have re ar (Draw existing and required addition an reverse side,) # �% � y p p ed this application and that the work will be done in,accordance with San Joaquin County Ordinances, State,Laws, an&Rules!" nd Regulations.of the Son Joaquin Local Health District. Home owner or licen- sed agents signature certifies,;the following: "I certify that in the perforrnonce of the work for which this permit is issued, I shall-not`:employ any person in such manner as to be a subject ta Workman' Compe cation laws of California."' Signed . f �;. ..r `----- - - ------------- f Owner F B C_ `' ti Title - ( other than owner) FOR DEPARTMENT US ONLY.,._r APPLICATION ACCEPTED BY ----- `� '=- = - �`-------- DATE -- j-1 zap 6 gg l BUILDING PERMIT ISSUED --"' --------- --DATE ------------ ---------------N-- --------- -•------------- -------------- -- `" �" ` ADDITIONAL COMMENTS ---------------- =' ' _ - -- -- -------- ---- - - - ------------------ --------------- ------------------- ------- ---------------- --------------------------------------------- t ----- " r - ------ t ------------------------------------ -------Date ----------------- ----------- ---------------- Final Inspection by -------- -- ------ I SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'b8 Rev. 5M,