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FOR OFFICE USE: _ APPLICATION FOR,5ANITATION--PERMIT .��.;. ------------- - - ----------------- ----- ' ., Permit --------------- (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 Ordina No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION __I- -Q---0_47 1-- - _ -~- CENSUS TRACT __________________________ Owner's Name -----1<......D .--- ---------------------- ------------------------>--------- p _Phone —-ac _c Addressf?7.+�r lEz_ `2� _�__ it?I� LE� City_ -- i_nd ---- -- r- - --- �. y rr��--�� } ( �� OO,Sr�I-----'Phone Contractor's Name -�.! .-C V_�':_�- }-+-Gf1�---- �----LT"-'------------------------License #�--- - . -- - Installation will serve: Residence Apartment House❑ Commercial :❑Trailer Court ;❑ Z16 Motel ❑Other ----------- - u... - / Number of living units:.-_/------ Number of bedrooms _'??____Garbage Grinder.______---,,Lot Size �✓---------- I Water Supply' Public System and name ------------------------------------------------------ --------------------------------- ---------------- Private Character of soil to a depth of 3 feet: Sand' ilt❑ Clay Peat❑ Sandy Loa Y Clay Loam ;❑ Pao, R. -Fill Mater�ial�_--=-- --:_If yes,type_------�-(----------- - (Plot plan, s4 i g 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,) •- i� PACKAGE TRfATA11ENT 'SEPTIC TANK'[ Siz _ .� � ---'��.'" `_ Liquid Depth.------ d_____________ C'� . 4a# Q Capacity 1�_Q_m- ____ Type Material---- No. Compartments _ -----.-•--••-.-- f i 1 Distance to nearest: Well _ - --___________________Foundationl__d --------- Prop. Line LEACHING LINE � No. of Lines ---I_______________--_ Length of eat �17�49_._---- .__--_- Total Length __-4d, -.___. _•----_-__ri •D' Box __.___4=--- Type Filter Material I� _____- th Filter,`1tiAatenal __ ..5_ ______________________________ Distance to nearest: Well __7-:47----------- Foundation -------------------___ Property Line _______�PIP...... SEEPAGE PIT [ Depth ____ rDiameter _/74 Number ----.___1__�_____K_---- Rock Filled Yes j< No i❑ f Water Table Depth --------------------------------------- P .( �. ---------------- � ----------------------------------Rock Size ` �j Distance to nearest: Well __l _ _____ --------_:..Foundation ____.!-__ --.--- Prop. Line ___;/" " .......... , REPAIR/ADDITION(Prev. Sanitation Permit# --------.------ 4-- --:---- Date ----- =--•------------1 t SepticTank (Specify Requirements) -------- --------------------------------------------------------------------- -----------------------------..------------------I-------- ' DisposalField (Specify Requirements) -------------------------- =------------------------------------------------------------------------------------------------`-- y ----------------------- v i----------- ` :--------------------------- ---------------------------------- ---------------- ---------------------------------------------------------- 41 *------------------------------ ---------- ------ ------ =---------------- --- ----- ----- --------- ----- - ----------- ---- _-----� --------- -� —(Draw-existing and required-addition-on-reverse-side) �--- _-- -^ 1 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 bec a sub'ect oak 's ensati laws of California." Signed ��- --- r.--- "`'/ ---------------- . , By -------------�----- ---------- - - ------------- _---- N ---------- Title - - ---------- ------------ (if r (lf other than owner) � � f FOR DEP NT USE ONLY ACCEPTED 13421--- -- -- ------ ---------- ---------------------------------- --------------------. DATE �s ------------------------ APPLICATION BUILDING PERMIT ISSUED ---- -- ----------- ------------------=---:--- -------------------=--------------DATE ------ ------------------•----------------- ------------------- ----- ADDITIONALCOMMENTS ---- ------ --------------------------------------------I---------------------I------------------------ -- ------- ----- -------- ------------------ ------------------- -- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ------ •----------------___________________ __________________________________________________--__________--_________________-______Y_________-.--_____________.______-_----_______-____________-----_______._____.__.----.____ ___ _________________________________________________________ ________________________------------------------------------------------------------------------_____________________________________ ----------------------------------------- -------- = D 7a---- Final Inspection by: r � ---------------- ate - SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M