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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ------------ � iComplete in Triplicate) Permit No. ..7:s.-`....... -- - --.•- • .............:................... f Thts Permit Expires f Year From Date Issued Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to constrtict and install the work herein described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations:,. JOB ADDRESS/LOCATIO .... 0.y .. . �I�J.1 .L�..............................CENSUS TRACT . Owner's Name ..._.._._..... .. 5� �� .,_ Phone . �. .... ........ Address ��" Gth. .Y ---- ....City .. .... Contractor's Name .-_ ._ a ...--- --- license !�/��,, . Phone ..`/� Installation will serve: Residence ' .partment Housa❑ Commercial❑Trailer Court ❑ Motel ❑ t t ,. Other........ ........•---•---•-----------.._.... 1 Number of living units:_....._ Number of bedrooms __...Garbage Grinder Lot Size .. Cir .......... Water Supply;! Public System and name Y - .....................................................private Character of soil to a depth of 3 feet: Sand D Silt 0 Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam 13, Hardpan ❑ "Adobe' Fill M6ter4dI1/.q..... If yes,type i (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,) �.. PACKAGE TREATMENT [ ] SEPTIC TANK{ /� ice. ..................... Liquid Liquid Depth ...'11� ............ 1 �/V / �-� Ct Capacity _�--------=-------- Type �- .... Materiab)-.._. . .......... No. Compartments ` l a.� - Distance to neorest: Well':--' ell':__ __7-................Foundation ..��.......... Prop. Line . LEACHING LINE [ No. of Linea ..___ _____.__--- Length each line. } ....... Total Len th ..7Q>> ........... 'D' Box y--e-). Type Filter Materia ........CA?......Depth Filter-Material .._I ... .............................. stance to nearest: Well .... .� Foundation _....f.�_._......... Property Line ..5. 2- ...........� SEEPAGE PIT [�pth --. ��------ Diameter Alt _ -_-'` Number -----D... ............... Rock Filled Yes i❑2 Water Table Depth Size /% -./!r, :-•---- O Distance to nearest: Well k •_•......................_..._ .�.__. .- jib,Foundation --_-- Prop. Line . .. .._..._.. REPAIR/ADDITION(Prev. Sanitation Permit=# --------------------•---------- ------------ Date .....................__•---------_-) Septic Tank (Specify Requirements) ---.-____=----------- - b -------••••----• -. --••- -•--•••••------------••................................... •..........------......-,..... { Disposal Field (Specify Requirements) ______________.._-------------- ------------------------------- ____________ ___.____._____---._....._ -----------------------------------------.---------------__t.1_. _.::--_______----__.-____-_.-__-_-_-______ -...._._.- •+ E (Draw-existing-and-required-add itiomon-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 Son Joaquin Local Wealth: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, .1 shall not employ any person in such manner as to become subject to orkman's Compensation laws of California." Signed ------- -------------• ------------ --------------------------- ------- Owner BY --------------------------------- ---- ----- (If other a owner) { FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY --- DATE ..:..=__-- --_- .7, Bt1iLDING PERMIT ISSUED73-- .. ................. ------------- ...-•---•------------ -- ............-DATE -- ADDITIONAL COMMENTS . .................... ......•--•-----.-------------- -•------------------•-••-----------•- •----•---....------- •-------- .._-..:......---....------.--•-----...-•---.......:.:..:_........ ............... ..............-..----------------•----- --------- --.--.....__..--.• -- ---------- .......... � Final Inspection b ,.................... p y: .............................:..........•--•--�---•-------------•--.....__ ._.._- -��--- - ?---._......_Date � 1�::.1t-7S EH 13 24 1-68 'Rev. 5m � SAN JOAQUIN LOCAL HEA H DISTRICT $/711 3M