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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No. --------------------------------------------------- ��-ae�. (Complete in Triplicate) / This Permit Expires I 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: _. / fin,, ------C51V__&FA 6S'f'TR T GUa�`--car z.c� JOB ADDRESS/LOCATION �-�/--l'-----�_��-----------a -----.-----�-�1-�� Owner's Name 2L2 --_- �sl�_/k1_�E `-- _ _ 'j� -------Phone ----------------------- -- Address �C, it ! ' 1 _� �--- ------ -- ---�_l_ q AlMr��o�-------------------------- y - -=- Contractor's Name ___. -..�r- -/- --------------------------------------License _!-_ � - Phone Installation will serve: Residence [�l Apartment House,❑ Commercial ❑Trailer Court ',❑ Motel ❑Other ------------------------------------------ NO Number of living units:--_ '.._ Number of bedrooms _„?______Garbage Grinder _---_- _____ Lot Size _-CM�06 _____________ Water Supply: Publ.dSystem-,and narhe --------------------------------------------- ----------------------------------------------------------------Private [ Character of soil to a depth of 3 feet: Sando Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ Hardpan ❑ Adobe ❑ Fill Material -V0--- If yes,type __________________________ (Plot plan, showing size of lot, location of system in relation to wells, buildin6s, etc. must be placed on reverse side.) NEW INSTALLATION: (No septic tank or seepa pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT f ] SEPTIC TANK Size_____V _�_ ------ 2____t,_ --_�_______ Liquid Depth ____ ---- ------------ Capacity Y,2-0-0---- Type __,P 6q-W Material_1 P_"_!� No. Compartments -_............. istance to nearest: Well -----67_0' _�_______________Foundation -- -- ---------------- Prop. Line -1:5 __._________ LEACHING LINEo. of Lines Z -- ------ Length of+each line----- -~--'----____-_ Total Lengthy _-_-_f_` ---------_----- 1 D' Box __ Type Filter Material _RG C __Depth Filter Material __-_1 ___________ _____�___.____.._.___ t r Distance to nearest: Well ------------ Foundation ---/0------�______ Property Line -,!5------------------- SEEPAGE PIT [ ] Depth ___________________ Diameter ------------------ Number ----------- Rock Filled Yes ❑ No E Water Table Depth __--______-_ t -------------------'--------- --- --Rock Size -------------------------------- Distance to nearest: Well ____________ _----------------------....Foundation _____________ ---- Prop. Line ...................... REPAIR/ADDITION(Prev. Sanitation Permit S# ---------------------------------_._________ Date __________________-_______________) Septic Tan (Specify Requirementsb------------- --•-- .L._ : Disposal Field (Specify Requirements) --------------- - - ------------------ - --- - - - --------'------•---•----------- i -------------------------------------------- f4--------------------------------------�---��-�-=,-`'---�--=--1------------` ---------------------------- ---------------------------- '----------------- --------------------------------------------------------------------------- �;� (Draw existing_and„requiired bddition_on_reverse side) I hereby certify that 1 have prepared this application and that the work will be done in accordance with San Joaquin County Ordinances, State Laws, and Rules and Regulations ofithe 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, Ii shall not employ any person in such manner as to beco subject-to Wor man's Compensation laws of California." ,fir Signed --- ----- t --' - -'zll� '--------------'---------- --------------------------------- Owner By -------------- --'-----------'-- -----------------,;---' Title ---- -•-----,--------- ------------------------------ (If other than owner) / FOR DEPARTMENT'IJSE ONLY ,/ APPLICATION ACCEPTED BYR`�� F-------------b -- ---- DATE ----�/ `I `6 `--------- BUILDING PERMIT ISSUED --------------------------------------------------------"----------- I---------------------------------DATE ------------------------------------------- ADDITIONAL COMMENTS = ---------- -------- --------------------------------------------------- -------------------------------------------- ----------------------------- V- - ' -t---- --- ---- li . - ------------cFinal Inspection - -- - ---- -- --- ----- ------ ---- e SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M