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FOR OFFICE=`USE:,: 4. APPLICATION FOR SANITATION PERMIT rr�� -------------- -- (Complete in Triplicate) Permit No. --------------------------------------------------------- This Permit Expires 1 Year From Date Issued Date Issued _el� Application is hereby made to the San Joaquin Local Health District for a permit to c""structrand install the work herein described. This`application is made in compliance with County Ordinance No. 5.49 and existing Rules and Regulations: _.. JOB ADDRESS/LOCATION .ZQ;�rDI-----` ------5`"F` - ---0 N N �-SC �� ---- -- .__CENSUS TRACT ______. _ 9__ Owner's Name _ FQ_-AI A f D------- (f /VF_{>_A------------------- ----- _ Phone Address 20CQ (_ '- )Q 14 1 ,� -----------. City --E—sc �-�C-SI----------------------------- Insfiallatio s Name ----- License # M PF?one - -=-------- ---------------ontractor i3t=.- 9 j Installation will serve: Residence Apartment House❑ Commercial ❑Trailer Court :] r -- --- - - -- Number of livingunits: Number bedrooms -13--, ___Gar \ - bage Grinders__Lot Size _1,5,A20` __a �— Water Supply: Public System and,nairEe ---------------------------------------------------------------------------------------------------------------Private Character of soiltoa depth of feet: .` Sand'E] ASiIf Clay E) Peat Sandy Loam .E] Clay am f, .:'/ Hardpan l Adobe E] Fill Materiaf -1 V_�--- If yes,type -----'----------------------- (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-otiseepa pit permitted if public -is-available within 200 feet,} r PACKAGE TREATMENT''.-.[ SEPTIC TANK'[ Size____ Xl d X ______- Liquid Depth ____ ____ ------------------ -- ------------- Capacity _�J�Q _-- Type DBE-__ kST-material_Con1_C.B-ET&o. Compartments ____ ._._._ % ----- -------Foundatio` ---- `477- - p ----- 9 •� stance to nearest: Well ,� [� _- Length of each line---- . �� _ Total Length Line,---,. i2 LEACHING LINE No. of Lines•:__ y I� D' Box/--��__* Type f=ilter,Material -_!'I-��___Qepth Filter Material _ __l9_ __/t_____________________________ Distant to n a.rest: II ___- - ------ ----7 F unda ion --- �D___ __ P operty Line SEEPAGE PIT [ Depth :_:__ amete` r Lf-_-_ _ _____ um r _______ _______/.__ _ _-___ ck Fill . Y s N Water a le D pth` D ock i e� J c ---:-- --- t rr J Distance to near : Well ---- -- -------------------------------- u dation ---- - ----------- Pro in ----- ...........__-- REPAIR/ADDITION(Prev. Sanitation Permit# --------_------------------------------------ Date ----------___________________--._-) Septic Tank (Specify Requirements) --------`>---------- ------------------------------------------------------------------------------------------------------------ Disposal Field (Specify Requirements) ------------------------------------------------------------------------- -------------------------------------------------- -------- --------------------------- ---------------------------------------- ---------------------- --------- -------------------------------------------------------- ------------------------------ (Draw existing and required addition 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 agents signature certifies the following: "I certify that in' he performan of the work for which this permit is issued, 1 shall not employ any person in such manner as to beco ject to Work n's :Compensation laws of California." Signed . --- - ------------- -- -- --------P--------5---------------------------------- Owner By ------------ ...... ----------------------------------------------------- ------- Title -- ---------------------------------------- ---------------------------- (If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY I ' `®-`-----------------------------------------------------------------=----. DATE ....f;9�------J-7_72----- BUILDINGPERMIT ISSUED --------- --- ------------------------------------------------------ --- ----------------------------DATE ------------------------------------------- ADDITIONAL COMMENTS_ - � ------------- ---_-------- - --- ------- _-. .----------------------------- ------------------------------------- ------ - --- - --------- - - -- - -- _ --------- --- ---_ _.-----------'- ------------ --------------- - _ - -------- ---- ------ --------------------- -------- ---- -- ------- --------- Ais - SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M F