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-FOR OFFICE USE: • `' - - APPLICATION FOR SANITATION PERMIT / S /✓/ r (Com lete in Triplicate) P it --------- ------ ---- - _ �3 e4m' Mo _ • x ---------- ---- - Date Issued `-�._ This Permit Expires 1 Year From Date Issued ! 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 CII unty Ordinance No. 549 and existing Rules and Regulations. i ® JOB ADDRESS/LOCATION _ ___ ® S��__ -----�7_'�X_E_P1 ___ _____^___________ ____--_-CENSUS TRACT Owner's Name ----------- J- --------- E�I-_f.0--- 9-----------•------------------------------------------------Phone 1 �c ^1.O Address ------------2Q 0.9 �----- = 1y '�------------------------ City ---- ----- -�l . Contractor's Name -- 40WAt --- -- ---------- # ---- -: ---------_ Phone ----------------------- •..... i Installation will serve: Residence.®Apartment House�E] Commercial 17railerrvew* i Motel r-1 Other -------- Number --Number of living units:----1------ Number of--bedrooms ._1.1-.__-_Gaebage Grinder ------------ Lot Size IfWater SuPPIY� Public System and name-_ �": ______ __ ---- --------------------------- E _S Private Rg,'"— Character of.soil to a depth-of 3 feet:__Sa d'❑ Silt,6. i� Ua r E]_: Peat:❑ Sandy Loam g2-' Clay,Loam-E]'-'_ - Adobe Fill pr Material _ _______ If yes,type ------------•`-- �- - -- Hard an { f (Plot plan, showing size of lot, location 6f system in re�liation'to wells, buildings, etc. must be placed on 'reverse- side.) i NEW INSTALLATION: (j septic tank or-fe'�ge pit p4mitted if public sewer is available within 200 feet,) PACKAGE.TREATMENT SEPTIC TANK ) r F t,L Q ' j Size X Liquid Depth( -! 9� °4 Capacity / 0 -------- TypePOUPF--r l, Material_CCQ.N'C.�ETFNo. Compartments ___ istance to nearest: Well p__ "--` Foundation Prop. Line LEACHING LINE C No. of Lines ------- - _- --"--Length of.each -------------- Total Length ------ Y7 'D' Box IV-0----- Type Filter Materlia` KQ:�j-_---Depth Filter Material 1_ _____ -__ ______ I Distance to nearest: Well ____f 94P? ____?�'__ Foundation _11)................ Property; Line _ ` _- Diameter __ -__.i.. Number --___ Rock Filled Yes SEEPAGE PIT Depth !-2__________ 7I- ��_ . _ __-1- _____ No Water Table Depth -----34p- , --------------------Rock Size - -- —_` Ze it ,r Distance to nearest: Well -__/00..-_ _;_____________•-•Foundation ---/__V_-_ -_- Prop.,jine _' ._.__. REPAIR/ADDITION(Prev. Sanitation Permit# __________________ ------ ----------- Date ---------------------------------- Septic Tank (Specify Requirements) �_ ---------altr l Disposal Field (Specify' Requireme ts] __.- .__._. ` - ( __.__: x ------------ --- -- --- (--- -- --- r ------------------ ko�. .- (Draw existing and required addition o.n reverse side) w.. I hereby certify that 1 have prepared this application and that the work] will be done in accordance'*ith San Joaquin Count Ordinances, State Laws, and Rules and Regulation's of the San Joaquin Local Health District. Home owner or licen- sed agents signatu certifies the following: i l "1 certify that in the perfprmance of the work for which this permit is tissued; I shall not employ any person in such manner as to beco subject t ork 's mpensatton laws of California." '' (( Signed ------ -- ------- -- ---- - ------------------------------------ ----- -- -------- Owner -- - - --- ------ -- ----------- - --- - -------------------------------------------------- ------ Title (If other than owner) FOR DEPARTMENT USE ONLY I I APPLICATION ACCEPTED BY + ► r r_� __,� + t �^ __ ____. DATE ,�D �� _ BUILDING-PERMIT-ISSUED- = - ------------------------------ DATE _ '------------------------ �A©DI;TIONAL COMMENTS _ f ' - - - --- --------------------- I------------------- -- - --- -- --- ---- -------- -- ------------------ ---------- - -- ----- - -- -- ----- ------ - - - - ---------- ---------- { R a { J - -------------- - -•-• - ----- ---- ---- - ----- - - - ° Final Inspec - ._ - _ 1#-`---- -------------------------------------- - — Date SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M }