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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ......... --.-=----'~----=--------•- ------ ------ •• Permit No. `:_ ____l (Complete in Triplicate)_, t. --------------------------------------------------------- This Permit Expires 1 Year From Date Issued Date Issued --"- -! Application is hereby made to the San Joaquin Local Health District for a perr'nit to construct and install the work herein described. This application is made in compliance with County Ordinance Na. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATIO -------------- -- CENSUS TRACT ---S----57---- - � Owner's Name ------ --- Q ---------1�7 0!& -------------------------------------- ------=---------------------- -------Phone ------------------------------------- Z -- ;----------------•-------------- Address . 3- QLD �}l r -------------- Citi ---MANTEc�-------- Contractor's Name _I _ ��ment ---------------------------License # ----- - -- --- ------- Phone -.----------------•--------•-- Installation will serve: Residence House❑ Commercial :❑Trailer Court ;❑- - � Motel ❑ Other ____-_-_ -----------------------��// // Number of living units:_.__ ._----- Number of b'drooms �------Garbage Grinde/_�_ Lot Size _./ &) 13 Water Supply: Public System and name --------- _ ° Private R9� Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑;0 Peat Sandy LoamClajj; oam ❑ Hardpan ❑,` Adobe ❑ Fill Material - �-- If yes, type __-----___________________ q (Plot plan, showing size of lot, location of system.'in -relation to:!wells, buildings, etc. must be placed on reverse side.) NEW INSTALLATION: (No septic tank or seep 3ge pit,permitted:jf,public sewer is available w hin 200 feet,) PACKAGE TREATMENT .[ 7 SEPTIC TANK'[ ] `�Sife ---------------------------- Li uid Depth -------------------------- -4 r .� Capacity------ -------------- yPe --------------,---- Material---------------------- No. mpartments ---------------------- Distance to nearest: ell __________________________________Foundation __.___---------- ----- Prop. Line ____-_____-_--______ LEACHING ZINE [ ) No. of Lines -------------- _______ Length of each line--------------------- Tot I Length _________,___-_______-____ L 'D' Box ------------ Typlter Material-`-------------------Depth Filter Materia -------------------------------------- Distance to nearest: l ________________________ Foundation roperty Liffe _________________......_ SEEPAGE PIT [ ] Depth ____.____._--------------- meter __ Number ..___._____ ock Filled Yes 0 NoWater Table Depth _________ ___________Rock Size - -- ---- Distance to nearest: ______________;___________________'__.__.Foundation -'--------- ------- Prop. Line .................... REPAIR/ADDITION(Prev. Sanitation Permit# ---------------- Date _____________ ) Septic Tank (Specify Requirements) ----FoR-------L3)FD t -----------A-PIl_nO _Y----------------------------------------------- Disposal Field (Specify Requirements) --_____�� 241_-_..____ RF—--__---E�--C_7C ---- ��1 1X$7 ------Bdx----------- ---------------- --- �-`-----�► ��------� F0----------fVAf� �-E�09 � jUE , {Draw existing and required addition = =' ---------------------------- dition on reverse side) 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-San.Joaquin -Local.Health District. Home owner or licen- sed agent signature certifies the following: "I certif th t in the pert nce of the work for which this permit is issued, I shall not employ any person in such manner as to beco su ject to man's Compensation laws of California." ` Signedf - C- -`---------------------------------- Owner By -- ------------------------ = -� �--------- Title -------------------------------------------------- (If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ---- -- ---f-�\- - DATE W � BUILDING .PERMaT-ISSUED _ - --- - - - DATE . t--••_------------- _ ADDITIONAL COMMENTS ------------- - -------------------------------- -------------------- - -------------------------------------------- -----------I------------------ -------- ---- ---- _.____-_ __ - -- -- - - - - _- ______ ____________________________________________ _____ i----------'T_-_. ___-- __ Final Inspection by: Date __ ._ _._ . _ SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M