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3 FOR OFFICE USE: - APPLICATION FOR SANITATION PERMIT - ----------- Permit No. - -- ---- (Complete in Triplicate) -------- --- -------1 � 7_ _________________________________ 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 ADDRESS/LOCATION . /--_ - EA15US TRACT -------------------------- Owner's Name -- G-- ----------- ------------------------------------------------------------Phone Address _______ o �'� -� ta- c`' - -- ------------ city �/'.�- -- -----I R Contractor's Name ------ '----------------License # �y�t�1 Phone !/• : a.� �� am � { ,T Installation will serve: Residence XApartment House❑ Commercial ❑Trailer Court ',❑ Motel ❑Other --------------------------------------------W& // & Number of living units:.__ ---- Number of bedrooms __ ____Garbs e Grinder�Y _.._ Lot Size _ __ x _°}�!...... Water Supply: Public System and name .__$4-11, .+ _----.__ ------------------------------------------------Privatek M Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ Hardpan ❑ Adobe NJ' Fill Material ------------ If yes,type ---------------------------- (Plot _________________________(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 ;,T SEPTIC TANK" Size___ �_ �K-�--•------------ Liquid Depth ---`5 ---------------- Capacity/0 614760Type 441tMaterial___ No. Compartments _.V.--------- Distance to nearest: Well ____r,S' _/---------------Foundation Aa------------- Prop. Line ....L:�---.r______ LEACHING LINE �( No. of Lines ---,Q.7- Length of each line_____ _. - __ Total Length __ . -_-.._.. ..... 'D' Box -__ Type Filter Material X4914-------Depth Filter Material __-AI_�______________________________ Distance to nearest: Well ___ _P_______ Foundation ----X4------------ Property Line ----J—../..__._ t� �r SEEPAGE PIT Depth -_.x.C�_r___ Diameter __ _ _____ Number _____o�_________________ Rock Filled Yes 1k No ❑ Water Table Depth -------- t7- ----------- ------------Rock Size --- -------- Distance to nearest: Well ----__ ________________Foundation ....el��-------- Prop. Line ---CS. ............ REPAIR/ADDITION(Prev. Sanitation Permit# ____________________________________________ Date __________________________________) r SepticTank {Specify Requirements) ---------------------------------------------------------------------------------- ----------------------------------------------------•--•- Disposal Field (Specify Requirements) ___________ _________________________________________________________ --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- (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 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 L.=, " 'cam._ � � Title Cf� (If other than owner) FOR D PARTMENT USE 9NLY APPLICATION ACCEPTED BY ------ -T_ ----- -- - ------------------------------ DATE --- --------------7 ---- ---- BUILDING PERMIT ISSUED _-_ _ ____ ___ ------------------ - __DATE __________________________ - -------- ---------------------------------------------------- -------------------------------- ---------- ADDITIONAL COMMENTS ----------------- -------------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- --- ------------------------------------------------ ,;Wj—- _ - -- --- -- -- ------- --- ------------ -- ---- -- -- - -- --- - - - Final Inspection by: ;`----- ----- ------------ - ---------- Date SAN JOAQUIN /LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M