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FOR OFFICE USE: �l APPLICATION FOR SANITATION PERMIT ---------- - ---------- (Complete in Triplicate) Permit No: --------------------------------------------- x w u // Y -------------------------------------------------__-!`---_- �, This Permit Expires 1 Year From bate Issued 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: JOB ADDRESS/LOCATION ------- -------- ----- -=- CENSUS TRACT Owner's Name �/t _I� - -- ------ -----------------Phone Address - { r,F ------- ---------------------------- City ---•- -------------- Contractor's Name - gyp! � , ------ License #Z '1-7.7-._. Phon -I-`-_- Installation will serve: Residence [] Apartment House,❑ Commercial:krailer Court ;❑ Motel ❑Other ---7&e '✓i_ Number of living units:-- Number of bedrooms -__ Garbage Grinder __" Lot Size fk`:_ _"_ Water Supply: Public System and name -__-_ _ __ ��c�_/ ✓[ -___ E :_________Private' - ---------------- Character of soil to a depth`of 3 feet: Sand Silt❑ Clay [] Peat❑ Sandy Loam ❑ Clay Loam ❑ N Hardpan ❑ Adobe ❑ Fill Material ------------ If yes, t s (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,) t r PACKAGE TREATMENT [ ] I SEPTIC TANK' Size------ `:_'d,�_ � --- Liquid Depth k.---1~-------------- capacity .-_-_-_ _.Capacity Type oPXC-4-AXX Material-e-aA,CXzr No. Compartments. Distance to nearest: Well -___ -----____-_-_-__.Foundation ----.�e -- �'_ ��----- --------.- Pro Line-- :�-_-_.:. ..... ' .. p. LEACHING LINE '' No, of Lines --____ . ____- Total Length __-------___ Length of each line-_____ _' . _ 'D' "Box _-_- -- Type Filter Material -- - ----Depth Filter Material ----____________________._..•-•... Distance to nearest: Well ---��'(-_-_---___ Foundation _. _ _ Property Line ---5 _r- ` SEEPAGE PIT4n L l Depth -------------------- Diameter ---------------- Number --------- ------------------ Rock Filled Yes ❑ No .❑ va , ' Water Table Depth Rock Size ----------------------- -------- at; ----- Distance to nearest: Well ------------------- -----------------Foundation -------------------- Prop. Line --------- ...... REPAIR/ADDITION(Prev. Sanitation Permit# ------.------------------------------------- Date -----------------------------____-} � Septic Tank (Specify Requirements) ________________________________________ Disposal Field (Specify Requirements) ------------------ - ------------------------------------------------------------------ --------------k----- -- ------I- ------------------------ -------------- ------- A I! (Draw existing and required addition on reverse side) I hereby certify that I have'prepared this application-and that the work will betdone iin 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 ,C ------- ------------------- (f other than owner) FOR P RTMENT US LY APPLICATION ACCEPTED i3 __ _f__ l ATE _fes __7x ------------------------- <, -------------------- ING PERMIT ISSUED -' - - j------ ---.---- -----DATE --- -------------------- -- lTIONAL COMMENTS ---A(_--------------___--_--_ _ - ------------=--------- -- ----------- --------------- -- -------------- ---------------------------- - ------- ---- ----- --------------------------------------------------------------------------------------- I=---------------- - --- ------------------- - 7% fG— -- ------------------------DateFinal Inspection by: - z' I SAN JOAQUIN�L &Al' HEALTH DISTRICT E. H. 9 1='68 Rev. 5M, ��