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FOR OFFICE USE: APPLICATION FOR SANITATIO P IT ` 75`- 5 ;7S— e, 5 lig- Perm+t No: b -- -- --- -------------------- ,----- - -------- - (Complete in Triplicate ----- ------ Date Issued This Permit Expires 1 Year From 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: -_ CENSUS TRACT JOB ADDRESS/LOC IONa� Phone Owner's Name ----- --`--W` ---- - r -- -------------- n- .._ ¢ — cit Address -- - -------- - `� Y S ,� �'`f 4- '`rG ------- Phone ; Contractor's Name . �� --------- I-- License # Installation will serve: Residence E]Apartment House-E] Commercial ❑Trailer Courti❑ i Motel ❑Other c s Number of living units:-__2-- Number of bedrooms _-__ _____.Garbage Grinder`* Lot Size _---- - -------- '---�, Private,- I ❑ y ! Y- Water Supply: Public System and name -------------------------------------------- -------------=-------------------------- Character of soil to a depth of 3 feet: Sand'❑ Silt Clay ❑ Peat❑ Sand Loam ❑ Clay Loam s Hardpan ❑ Adobe'❑ Fill Material _! - If yes,type --------------------- � g r (Plot plan, showing size of lot, location of system in relation to wells, bindings, etc. must,be placed on reverse side.) ' NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) I PACKAGE TREATMENT Size------------ - ----------------- ------ Liquid D'epth ----------------`--- Vi.{ ] SEPTIC TANK'[ ] - Capacity: Type -------------------- Material------------------------ No. Compartments --- ......••. 6 I Distance to nearest: Well ------------------------------------Foundation -- .---- ^t Line --------•----=-----•--E tv LEACHING LINE [ ] No. of Lines ------------------------ Length of each line-:______ Total Length ___.___._ . .; 1 'D' Box ------------ Type Filter Material --------------------Depth Filter Material ----------- Distance to nearest: Well _______- •-------- --------------- Foundation ----- OT---- ---- ----- Property Line -----••------._.... � i SEEPAGE PIT [ ] Depth Diameter ________________ Number ----------1-- -------- ----- Rock Filled Yes ❑ No-❑ d IL Water Table Depth --------------------------------------------------Rock Size --------------- ---•----- ___"_---- •- Distance to nearest: Well __________________________ _Foundation°'."""""--------- Prop. Line -------•-- _...---- --- REPAIR/ADDITION(Prev. Sanitation Permit# --- Date ----------------------------------] . y �_ -- - --------------------- ------------------------------- -------- Septic Tank (SpecifyRequirements) -___ ---- # t x = Disposal Fi 1d (Sp ifyl Requtrgrnents) ------------- ---- ----------•----- ---- ----- ----------------- c - ----------------------------------- s. ------------•---- ------- -------- �t_�--- - -------------r-------= - - -------- �I _ --------------------------- ---------------- � s p.----- -----------------w - I raw existing and required addition on reverse side) y s; 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 Son Joaquin Local Health District. home owner or icen- 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 sub ject-t orkman's Compen 'I)ion laws of California." Signed 4C- A ( .G __ - ' -------------- pwm-r Title ----rol, - --------- (/ BY ------ --------- - (If other than owner) F DE AATME USE ONLY e ! —.� 7 APPLICATION ACCEPTED BY ----- --------------- �_ ---- ----------- DATE _.1 - ---- .. __ DAT -- ---------- --------------- BUILDING PERMIT ISSUED ------------------- - - -- ADDITIONAL COMMENTS ._ -------------------------- ---- --- ----- ---------- ---- ---------------------------- ----------- --------------------------------------------------------------------------- --- - ------ --- ----- ---1--------- Final Inspection b Dare SAN JOAQUIN LOCA-L---H` OCAL H ALTN DISTRICT F E. H. 9 1-'68 Rev. 5M