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+FOrt OFFICE USE: APPLICATION FOR SANITATION PERMIT r � --6---- ---------------------/I---------------- w- Permit No. (Complete in Triplicate) --------------------- - -_-_ z Application is hereby made to fhe San Joaquin Local Health District for a permit to construct and install the work herein described. This tion is ade in compliance with County Ordinance No. 549 and existing Rules and Regulations: JOB AQQRESS/L ATION %_Ve_aZ�--- ' si c � �� ------------CENSU TRACT _ _ � �- / Owner's Name �-�-�--- ---� f �-�---=-/- }� - ------------------- -- ------------------ =- --------------------Phone ------------------------------------ City ----- - -----------------•-------- �.2- ' s--�' = F / Cit ��u /Z ------------------ _ Address --------- ---------- Y Contractor's Name --- — -2 ----------------------------- License # -��-r --,` _ Phone Installation will serve: Residence 91�pclrtment House,❑ Commercial ❑Trailer Court ,❑ Motel ❑Other ---------------------------------------- .5 Number of living units:--------1_._ Number of bedrooms __r_,,,�}-Ga77rr-bage der acs____ Lot Size _ �/"-v Water Supply: Public System and name _ 1S Q 1.- r / Private ❑ Character of soil to a de Pth of 3 feet: Sand'[I. I F] Clay ❑ Peat E_ Sandy Loam ❑ Clay Loam ❑ Hardpan ❑ Adobe i 1 Material _r----- 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 or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT { ] SEPTIC TANK; s S' _ _ -- ----------------- Liquid Depth --- �iw ~77 Capacity -__ _ , Type d aterial__ No. Compartments ______.-s�.,..v-_._- Distance to nearest: Well __ __________________Foundation Prop. Line _______.-.....-____ LEACHING LINE No. of Lines -----)------ ____ ____ Length of Acich line---- _ -------- Total ten th .. 'D' BoxL),--- _�•___ Typ e Filter Material"� �---Depth Filter Material ___- _____________----_l__._______... Distance to neTrest: Well _.___`—_____ .___fFoundation ----1 ------------ Property Line. S_____________________ SEEPAGE PIT Deptha-S____________ Diameter __________ Number ._____.�____._,-�_-_____ Rock Filled Y.e No ❑ Water Table Depth _______._- -------------------•- Rack Size Distance to nearest: Well ---------------------------________----Foundationl_ _--r._- Prop. Line ......... REPAIR./ADDITION{Prev. Sanitation Permit# -------------------------------------------- Date ---------------------------___---_} SepticTank (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 Ordincnces, 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 become subject to Workman's Compensation laws of California." Signed ------------------------------ ------ Owner BY ---------------------------- - ----- l -1 itle --cam ------------------- (If other than wne FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY - - DATE _. _-L _`_.7Z--------- BUILDlNG PERMIT ISSUED ---------------- ----------- ------ BUILDINGDATE AD ITIONAL COMMENTS _ - b"- •`---- --�-1 __/ --------- ---------------------------------------------- --------------------------------- ------------------------------ --- - - - -0 ___ ____ _ _______________________________________________________________________________1___-------_.___.__._ __.__ _--- _____ ____________________________________________________________________________________________________ _____:______.. Final inspection by: ------ ---- -- -------- - - ---- -- - Date E`- ` s AN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M