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FOR OFFICE USE: .. ..................... APPLICATION FOR SANITATION PERMIT (Complete in Triplicate) Permit No.ZY::: QA2__f _......................................:......... .. .... This Permit Expires 1 Year From Date Issued Hate 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. 5 and existing Rules and Regulations: JOB ADDRESS/LOC ON CENSUS TRACT 7... .�_. Owner's Name Addy7� . ... - _ ._ ........................ . .......,..Phona3 .. . ..�,. ; _ Address . . .- • � ,fr . .. _. . .- ---- ............. .._. city . ' L�-��, Contractor's Name i . ..............Llcense.� � :W.. Phone Installation will serve: Residence �artment Housefl Commercial.❑Traller Court Motel 0 Other Number of living units:_..__:. Number of-bedrooms ----., " ._Garbage-Gr#nder -` .:.. Lot Size Water Supply: Public System and.name------ .. •••--••..- ----_._ .� ........,.....................�_. .-.....private Q.�- f Character of soil to a depth of 3 feet: Sand Silt ❑x ;�.Clay Peat'❑ Sandy Loam ❑ Clay Loam ❑ Hardpon'fl Adobe' FlII Materia) } 1� ......_..--- If yes,type .. (Plot Plan, showing.size of lot-location of-sysl-ern in r'el'ation 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 ( j SEPTIC TANK" :' ' P � . Liquid Depth ._...�t�._ . ....... JJ Capacity _-l. OC----- Type 1• •-------- --- Material__..Q. _�.. -No. Compartments ...... ............ Distance to nearest: Well . l - FoundationO d � 0 ------------- 2.0- -•---•............. Prop. Line ._.......-............ LEACHING LINE [11' No. of Lines ..__.3.------------ Length of each line__..__ 2 �.�, �/ Total Length ......��f�.......... 'D' Box .J .._ T filter Material l`.' �/j4.�_Depth .Filter Material ...1../... 1 Type. filter .............................. Distance to nearest: Well ..............6 ..__. Foundation .. _-.._.. property Line ..ee - 9 SEEPAGE PIT p o�� /i (}� Depth ---------- - ----- Diaomete --.-------- Number -- _ ........ Rock Filled Yes � No 0 Water Fable Depth _.___..% ._._ ;. l...................Rock Size ..�. J :......._ Distance to nearest: Well 'C ----_- ................Foundation .................... Prop. Line ....--- REPAIIR/ADDITION(Prey..Sanitotion Permit# ----..--•---------------------•------------- Date .............._.._..._............ ) Septic Tank (Specify Requirementsl. ..............•_•-- ..........................-....................I.............. ..._..._........ ................... I Disposal Field (Specify Requirementsl --•----------- -•- - ji (Draw existing and required add it#on on reverse side) 1 hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin i County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health:District. Horne owner or licen- - ' sed agents signature certifies the Following: i "1 certify that in the performance of the work for'which this permit is issued, .1 shall not employ any person in such manner as to,bAecomeub•ect to Workman's Compensation lawsof California."Signed _-. _. -------- OwnerBY -- - s,� -••---------•-------•---- ----- Titlef other than owner) FOR DEPARTMENT USE ONLY � APPLICATION ACCEPTED BY --- - ------------- - - ----------•----------•---------- -- DATE . ) - BUILDING PERMIT ISSUED _.... - ADDITIONAL COMMENTS ----- ---------------------------------------•-•---:- ---------- __DATE ....... ................ ------ - -------------------- A Fina! Inspection b -- --- -----_- --- -- P y: .... ! f -----..Date ...../ ...EH 13 2L 1-68 5m :.. .._.._ f SAN JOAQUI LOCAs. HEALTH DISTRICT 8/74 3M i