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FOR OFFlC.E USE: APPOCATiON FOR SANITATION PE - s� �d (Complete] i�licctLe �17 Permit No. e----- ------------------------------------------------- -------------------------------------------------- ♦ :: This Permit Expires 1 l=ram�Dafe slue Date Issued /7-_--�J___-- -------------- - ---- --- ---- ------ P 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: 1 � JOB ADDRESS/LOCATIO W�-_.�"�E�.,��_.��__t��-�+� -- ----.--CENSiJS TRACT ---------------Phone -------------------------------- -- Owner's Name G ----OA,.� /----------------------------------------------------------------------- ------ - Address �7 f -- 14) $ 4 -�1 -- -:14)_City 6" --------------------- Contractor's Name _ -- ------.License Phone,9jK-3 --- 16--- Installation will serve: Residence []Apartment House❑ Commercial ❑Trailer Court Motel ❑ Other .___-.a/o7gA? Number of living units:---- Number of bedrooms __________Garbage Grinder lIQ_ 'd� _ Lot Size a Water Supply: Public System and•name-------------------------------- -•---------------------------------------------------------------------------Private Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat X Sandy Loam -❑ Clay Loam :❑ Hardpan ❑ Adobe-❑ Fill Material ------------ If yes, type _______________________---- y (Plot plan, showing size of lot, vocation of system in relation to wells, buildings, etc. must be .placed on reverse side.) , 4 NEW INSTALLATION: - ,(No septi tank or seepage pit permitted if public sewer i ,) available within 200 feet 10 PACKAGE TREATMENT { ] i SEPTIC TANK Size,_ ------ ------------ quid Depth --_- C pp r"� :_ Material 411vi .:_._..___" No. Com artments I.Capacityr±Cf Q TYPe �{ �,. P. •' �I Distance Ito,.snearest: Wei l ___ _____________________Foundation ZP--------------- Prop. Line _ __..__.... LEACHING LINE No. of Lines-__l___________________ Length of each line-. -_ZX_Z_�____ Total Length .� .r- '€-r I 'D' Box Type'Filte'r Material/-A1*4 -_Depth Filter�Materaaf ��________________________ti,__.__-_._ i ',. Distance-to nearest: Well - -------------- Foundation f&----------------- Property Line. &Q__-_______-_____ '' _.--__ Diameter _ Number t---- Rock Filled Yes ❑ No i SEEPAGE PIT [ ] Depth --i---------- � --------------- -- ,. � �C Water Table Depth ------------------------------------------;----Rock Size -------------------------------- Distance to nearest: Well------------------_----------------- ----Foundation _•_________________ Prop. Line ..,,.___--____________ L`a f REPAIR/ADDITION(Prev. Sanitation Permit# ------- `'-_--------------- __________`-4-Date Septic Tank (Specify Requirements) r 4 2 a *31 Disposal Field (Specify Requirements) ------------------------- V ____ ____________________ ________________r i ------------------- +----------------------------------------------------------------'--=------------------------------------------------------------------------------ I ` ---------------------------- ------------------------ - -- -------------------------------------------------------------e--------------------------------- - -- ------------------ (Draw existing and required addition on reverse side) I I hereby certify that I have prepared this application and'that this work will be done in accordance with San Joaquin County Ordinances, State Laws, and Rules and Regulations bf_the San Joaquin Local Health District. Home owner or licen. sed Agents signature certifies the following: "I certify that in the performanceof 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 � �. � 74..•i lTl\4 i i ' Signed ---------- - -- - -- ------- ----------- ------ Owner's" ► ----------- --------------------- Titer ( '' BY ----------- other than ow er) ? ` i' FOR DEPARTMENT USE ONLY j APPLICATION ACCEPTED BY ------------------------------- DATE --------------- BUILDING PERMIT ISSUED _ &:i��.,hi __ --------- - ADDITIONAL COMMENTSi�-V,- G - � _' - --. f �: _ - ---------------- --------------------- ---- --- 1c,----A --- 'U = ' ------- --------------------- - -------------- ------ ----------------- ---------------• x Date ---------- - Final Inspection by: _._ --- ------- --- SAN JOAQUIN LOCAL HEALTH,7,DISTRICT E. H. 9 �1-'68,Rev. 5M rat: