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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ------------------ --------------------------- y Permit No. ---- - ------ � --- 7�'complete in Triplicate) ---------=----------------- -------- -----------'-----to `y Date Issued Kt !'%L This Permit Expires 1 Year From Date Issued W , Application is hereby madlSo Joacl&in Local Health District for a permit to construct and install the work herein described. This application�* e n compliance with County Ordinance No. 549 and existing Rules and Regulations- A&). egulations: JOB ADDRESS/LOCATION . � �Z&i- --- :-- . .r - N f - ______ _____ ______CENSUS TRACT __ Owner's No' -------------------- Address 1iw-__�--------------------- Phone + �+" r=l 6�_� ---UES 1_Q �� ------f City - ---------•-------------------------------- Address - Confir i � t Contractor's Name _Q1111/JE -License # �--Rhone " fL`� I Installation will serve: . Residence ❑ Apartment House-E-1 Commercial:❑Trailer Court ,l❑ rMotel ❑ Other --------------------------------------- --- SK--ISj } }} _ Lot Numbet of livingunits:___(------- Number of bedrooms �_------Garbage Grinder Size - ----- -- ------ ' `} ' '---i-------------------Private 2 1 Water Supply:, Public System and name _________________ ___________________ ____ - Character of soil to a'depth of 3 feet: SandSilt[1 Clay ❑ Peat Sandy Loam ❑ Clay Loam ❑ << <� Hardpan F1Adobe Q Fill Materia � f yes,type --------------------- --- (Plot plan, showin6 es•ize of Iot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) NEW INSTALLATION (No septic flank or seepage pit permitted if public sewer is available within 200 feet;)_- r� PACKAGE TREATMENT ISE TANK Sie_ 3 ( 7 [� x 7 _ Lquid Depth --- v--•--------.---- Capacity _/b_o0---- Type _1315fAB- Materials � No.f Compartments ------------ --- 1 N - #' f< Distance to nearest: Well ___ _t,__` --------------Foundation jt ___" ___-- Prop. Line ---- _:.-----.- O I 1 �� { ` Total Len th LEACHING LINE } � No. !f Lines ________________________ Length .of each line '_ ___ g� ,� ------------------ -- I �� 4 D' Box 7 �" -_ Type Filter Mate(al _a _ J F_-Depth Filter Material ___ ._:___. n .r.r i (.- f._ - Distance to nearest: Well`__---�------ Foundation .__l ______ '—_____ Pro er Line M .. SEEPAGE PITi O 'r ) Depth ------------------ i Diameter ----__---------- Number ;---------------------------- Rock Filled Yes ❑ No 0 r __Rock Size --------=---------- ``j ! (-"Water Table Depth ----:-------------------------------`-- €I ` E 4 Distance to nearest: Well ----------------------------------------Foundation -------------------- Prop. Line _.-----------:--•-•--- 4_4 I , REPAIR/ADDITION(Prev. Sanitation Permit# --------.----------------------- ---- Date ------------------------------ ) Septic Tank (Specify Requirements) --------------------- -------r r - ------------------------------------------- Disposal Field (Specify Requirements) ---------------- ------------- ----------------------------------------------------- F _ . ,ry - # - ' -----' --- ------- ------ ------- ------- -- = ------------------------------- ------------- - --- )-� (Draw existing and required addition on reverse side) I hereby certify that.I have prepared this application and that the-work_will-be._doneriri-accorda ce_with San Joaquin I 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 thai in the.performance of the work for which this permit is.•issued, 1 shall not employ any person in such manner as to become;sub)e "t to Workman'smpensation laws of California."- 1 Signed ��__�_ , , -------- --- - `------"------------------------- Owner s i -•-s— ..._..F. - . F BY -._.._ ', .-_ wc. -_'';-' Title ---------------------- i j(If other than owner) ' FOR DEPARTMENT USE; ONLY I APPLICATIO ACCEPTED BY ----- 3_ _A -------------------------------------- --------------------------------- DATE ..../. ------ BUILDING~PERM}T rISSEJED-.--.._, v.___,--�__:=--_-�_:.._------ - v. _ L _ �.. :-:__-_DATE-- •_-: = =-= ------ ADDITIONAL COMMENTS _ ------ ---------------------------- vl)L _'_1rVT14. R TN r}- _ M ._ ..,--__-----._-_-- ------._._.w_ . -------------- ----- ------------ ----------------------------- ---- ------------------ -- -- ------- -------- --- ---------R R Final Inspee - bY: �--- Date ---- R SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M