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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT y � Permit No: ��- ----------------- - ----------- (complete in Triplicate) - - Date Issuedj.-/ "-�� This Permit Expires 1 Year From Date Issue Application is hereby made to the S�n Joaquin Local Health District for a permit to construct and install the work herein e with County Ordinance No. 549 and existing Rules and Regulations: described. This application is made in complianc�`3 - .��r1! � rL�� % A /F_CENSUS TRACT --------------- ---------- JOB ADDRESS/LOCATION ------------------ Phone ----------- Owner's Name ze[- � _ �� -------------------------------------------- - Cit _-6-7_Z9 < 7 '� ----------------------- Address -' 3-------- �0'� 'C7VTC/ �t -----------------------7_ Y - - -- - - - ----------------- - _ Contractors Name -�1� ------SF .1�� 6�",_1'-C�/C-. -- # �Z?.(t� 3 Phone `/ Installation will serve: - Residence ®Apartment House-E] Commercial : Trailer Court .0 Motel ❑Other ---- ---------- -------- ----------------- Number of living units:....I__._ Number of bedrooms ___A/------ Grinder _,N40 -- Lot Size --�- -- Water Supply: Public System and naPrivate,0 me ----------- ------------------------------7----- - t Peat Sand Loam ❑ Clay Loam ,E] Character of soil to a depth of 3 feet: Sond'❑ Silt Clay ❑ ❑ y Hardpan F-1Adobe-E] Fill Material ------------ If yes,type ----------- » (Plot plan, showing size of lot, lo'ation 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,) 5EPTI�C TANK Dd Size--- Z�-.'Z_TV- - Depth --•------ -, Liquid D ` PACKAGE TREATMENT [ ] o. "Com artments Capacity C1 YP SMatenal_ P ` --------------------------Foundation ----lQ ---- Prop. Line ---�- Distance #o nearest: Weil ___�-_�_r'_ I ` _---- --_-- Length of eachline__ ---- Tota! Length :- --4-0-------------•-- LEACHING LINE [' es ------ ------ - o C/c Depth Filter Material -------If------- -------- ------------- Do Box _1Y_0__ Type Filter Material _/P_-- - ------- P �Distance to nearest: Well -____ �-_-- ------ Foundation ----1©--e----------Property Line __s___-----•-------- 10 � SEEPAGE PIT [ ] Depth _ Diameter ----------- - --- Number --------------------------- Rock Filled Yes ❑ No Water Table Depth ---------------------------------------------- Rock Size --------------- il Distance to nearest: Well __-_---__---------------- foundation Prop. tine --_------------------ .1 _...1 Date -------------------- ` '--•---•i REPAIR/ADDITION(Prey.'Sanitation Permit�# ------------- _.. Septic Tank (Specify Requirements) -------------------- Disposal Field (specify Requirements) ---------------------- -------------------------------------------------- ------------- tt -=------------- ---------- E -------'---'------------------------ --`------------`-------------------------------------•------------------------------------- -------------------------------------- _. i (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 j 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: certify that.in the performance of the work for which this permit is issued, I shall not employ any person in such manner was to becom 'subiect W rkman's Compensation laws of California." --------- Owner ' ,Signed - —I--- BY - -------- - '� ---- ------ Title (if other than owner) t o FOR DEPARTMENT USE ONLY ^15 _`i i DATE APPLICATION ACCEPTED BY _-- --------- ------------------------------------------------ BUILDING PERMIT ISSUED --- --- ---------- --------- DATE ------- ----•----------------------------------------------------------- - - ADDITIO--N--A--L --------- ------- ---------- ADD1TlONAL--C--O---M--M---E---N---TS ---------------------- --------------------- - - ------------------------------------------- ------------------------------------------ ------------------------------------ - - --------- --- ---------------------------------------------------------------------Date ` �i s�- 7lJ 1 --------- - -- Final Inspection by: __'--------- - '': -- - -- --- - - - ---------- ---- --- --------- # SAN JOAQUIN LOCAL HEALTH DISTRICT - .._-4 E. H. 9 1-'68 Rev. 5M.