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oR OFFICE USE: AP LICATION FOR SANITATION PERMIT ---------------°`= - Permit No. (Complete in Triplicate) --- ------------------------------------------- ---------------------.-------------------_---------------- This Permit Expires 1 Year From Date 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 c.�f-ADDRESS/LOCATIO_N ---?1_I� ----,!"_-Q5��-•UD CENSUS TRACT Fr Owner's Name _ ------1_�4 65�---------------------------- ----Phone._�'�1-`�-.`.��U.--•--- Address ------ --9J/�---------- awls- ----- ----------------------------- City_S5 i -- --6C a.'6f------------ Contractor's Name ----- -- - - -------------- --------------.License # ��-��--/�----- Phone --- ----------- -� Installation will serve: Residence [T<partment House❑Commercial :❑Trailer Court i❑ Motel ❑ Other =-------------------- : it Number of living units:____ ____ Number of bedrooms ___ ---Garbage Grinder ________.__ Lot Size _---_'-___________s_________________________ i Water Supply: Public System and name ---------------------------------•---------------------------- ---------------------- ---------- -------.Private W__ Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay LoamJ❑ ~ Hardpan ❑ Adobe.p Fill Material ------------ If yes,type ------.-4--------------- , (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 [ ] iiSEPTIC TANK f ] Size------------------------------------------------r Liquid Depth ----------------_._------- 7 zts Capacity -------------------- Type ---- --------------- Material---------------------- No. ' Compartments •--•------- I Distance to nearest. Well -----------------------------------Foundation ----.----------------- Prop. Line ---------- 7-- - ' -- LEACHING LINE [ No. of Lines ___--______�____:--": Length of each line7_._._-V ___________ Total Length -------- _____ . 'D' Box ------I.--- Type Filter Material Depth Filter Material _____/k`"__________________________ Distance to nearest: Well __; _____________ Foundation I__.� _-_-------. Property Line __- __-_ SEEPAGE PIT / Depth ;�-- _J------- Diameter -- -3_�p_-- Number ------------/ C�'! s ---------. ,Rock filled Yes [1 No i❑ Water Table Depth ----------- ------------------------------Rock Size -----/ �z �--_------ _ - Distance to nearest: Well ;__•___ ------------------------Foundation __!c�s----___._- Pap. Line ___._*5..__--.-_....- 4"AlR/A NVON{Prey. Sanitation Permit# --1-----f------------------------------ Date ---------.-------- --------------_)4 Septic Tank (Specify Requirements) -----`--------- ----------------------------------------------------------------------------------- - �., -- -------- ----------------------- Disposal Field (Specify Requirements) ----------- -----------------------------------------±--- ----------------- -------------`---------- ----------- - _" L ( j ----- ------- - - - ---------------------- ---- - ---- ----------------------------------------------------------------------=----------------•---------------------------------------------------------------------------- �• (Draw existing and required addition on reverse side} 1 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 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." I Signed � ------- --------------------------------------------- Owner BY1 •-�� '� [� aa> 'Title ----L , ------:----- (If other than owner) Fjr6R DEPARTMENT USE ONLY ----------- APPLICATION ACCEPTED-BY-_. -. -_r. -' ` atL DATE --�--. �- BUILDINqPERMIT ISSUED ----------- --------------------------------------- -------------------------------DATE --------- --------------------------------- A AL CO MENTS _ ---------------------------- - i -- --- -- - .- — t C----- -------------------------- -------------------------------------- ---------------------------------- ---- -------- - -- ---=-------- ___ Final Inspection by: ow ----Date ---------- ------------------- ------- SAN JOAQUIN LOCAL HEALTH DISTRICT i E. H. 9 1-'68 Rev. 5M