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---- FO_ R OFFICE USE: N1A�c, P0. �� S( APPLICATION FOR SANITATION PERMIT ., 71--6-7-Y. --- - �-------------- ----- -- .- (Complete in Triplicate) Permit No. -- -�- ____________________ 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 ------11-0. �'1 ,-�/V.+�?L.. --------- 0r,-4Q -------_------------------CENSUS TRACT -------38----------- Owner's Name -- 1-4- SAN-0-------------- ----------------------------------------------- -------------------Phone9'82- y 7 g ---1 )J a_�F_t'---------PAID. City ------------ - •- -'H12rz�.1 C F L�'�q y/Y\-(?- ' Address -- - --- -------=-------- C�_"I--��-------=--- 1 Contractor's Name --------------- ------------- ___------ Phone -----------------------=--- License # ---- -�---' - -- Installation�will serve: Residence MApartment House❑ Commercial :❑Trailer Court i❑ Motel ❑Other ---- - ------------------------------------- Number of living units:_.__------- Number of bedrooms ___3____Gar6age Grinder ___N6__ Lot Size ------- C.k-�c------------------ Water Supply: Public System and name ______________________ Private , 1`1.61NS=, Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat❑ Sandy Loam DK Clay Loam ❑ F Hardpan ❑ Adobe ❑ Fill Material __________ If yes, type ---------------------------- (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 Size-------------------------=---------------------- Liquid Depth ----_--------------------- Capacity __A. oType --Q0YXA Material---------------------- No. Compartments ----:97-----• :-•-- b E r Distance to nearest: Well t------------9_5___-------------Foundation ____._ ------- Prop. Line ------Im:-"f .._ v LEACHING LINE [i No. of Lines _..___ �___ __________ Length of each line-------- ------- Total Length ______2U0___ (J� 'D' Box ._._ ------ Type,Filter`Material ----Depth Filter Material _________ _________________ 1 Distance to nearest: Well ___ ___ ------ --foundation _._____- Property Line _-__- _---__ SEEPAGE PITDe th [ ] p -------------------- Diameter ---------------- Number ---------------------------- Rock Filled Yes ❑ No .i❑ �r WaterTable Depth ------------------- ---- -----------------------Rock Size -------------------------------- Distance to nearest: Well ----------------------------------------Foundation ---------------- ---- Prop. Line -_._•-••--•-----•___-- E REPAIR/ADDITION(Prev. Sanitation Permit K# __________________-----_____.___.__________ Date __________________________________) S Septic Tank (Specify Requirements) --------------------------------------------------- ------ DisposalField (Specify Requirements) --------- ---------------------------------------------------------------------------------------------------- --------------- 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 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 , .z-c ------ -------------------------- Owner BY ------------------ ------------------------------------------------------------------------------------ Title ---------------------------- -- -- (If other than owner) FOR DEPAR ENT USE rONLY APPLICATION ACCEPTED BY L!s V ---- ------------------------------ DATE-----� 1 ----------------- BUILDINGPERMIT ISSUED ---------------=----------------------------------------------------------------- ----------------DATE ------------------------------------------- ADDITIONAL COMMENTS ----------------------------------------------------------------------------------------------------------------- -=----------------------------- ------------------------------------------ ------------- ------------------------------------------------------------------------------ ------------- -------------------- --------------- 1-�--�--V--�_ ------------ Y- -------------------------------- Date- Final Inspection by; SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M