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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT , - Permit No. - IComplete in Triplicate) Date Issued -------------- - 1- -_--_--_-._ ---- This Permit Expires 1 Year From DaMlssued Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This application ismademaade in compliance with aunty Ordina a NQo. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATI } 0)4 v [ ......_. . ----- .'+------------- -------CENSUS TRACT --5-4 ----...._- - - Owner's Name - - -i4h - - _..--.z ------- - one ........... - - Address .. - QJ� - -.----. City - -- - - F Contractor's Name ._ _ r /d ----------� �--_-- -- .. a.-.....License Phone ...............- -.......--- Installation will serve: Residenc $Apartment Houseo Commercial[]Trailer Court ❑ Motel ❑Other ------------------------------------------- Number of living units;---- ...... Number of bedrooms A-__-Garbage Grinder ------------ Lot Size -Q4U.47Q Water Supply: Public System and name ---------------------_--------- --------- -------.. .......................Private (� Character of soil to a depth of 3 feet: Sand Silt❑ Clay ❑ Peat❑ Sandy Loom ❑ Clay Loam ❑ Hardpan X Adobe ❑ Fill Material ------------ 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 i ublic sewer is available within 200 feet,) PACKAGE PACKAGE TREATMENT [ ] SEPT C TANK Size__ .-.X--./. X..S.-_.-___. Liquid Depth T-......_-....___- o Capacity . . . . -.- - TYp . Material.. - ----- No. Compartments - ---....-_-.- \ / Distance to ne si: Well ...................................Foundation - ----- art...-----. Prop. Line ..-`j ------------- LEACHING LINE No. of fine's`------ Length of each line---- .43-C'--- -- ------ Total Length ----- --Q-V-------------- /� n 'D' Box .'�... Type Filter Material .....s�_.l----Depth Filter .Material ........................... s Distance to nearest: Well ____ p-jc ....._. Foundation --------LC......... Property Line -------9............. SEEPAGE PITC L( epth ----- _-�..r:.... Diameter -- ---��..---- Number ------------ ----- Rock Filled Yes It No ❑ y. „ r, Water Table Depth - - --�----------------...........Rock Size ....1---�`.....Xr Distance to nearest: Well -------------- o..--.-..-.........Foundation '..-J. -�.._.._.. Prop. Line ._-_---4-..-....--. REPAIR/ADDITION(Prev. Sanitation Permit# ............................................ Date ---------.-_----_----------....) Septic Tank (Specify Requirements) ------------------------------------------------------............................................................----_........... .-__ Disposal Field (Specify Requirements) ---------- ------- ----------- -- ..................... --......--- .............................. ........ ............. -------------------------------------------------------------------- .............................-------------------------------------------------------._......................................... ----------------------------- - - ----- ..----------------------- -------- .............. ------------- ........................... -------------------- - _.....-- .... - (Draw existing and required addition on reverse side) 1 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 of the San Joaquin Local Health District. Home owner or licen- sed agents signature certifies the following: "1 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 man's Compensation laws of California." Signed ----------------------- ----'----.-p - -- --- Owner SCj pie ------ -- i ................ title r(L�^Lti /�4 ..... ---------------------- ------------ By ---- -------------- - 1 (If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY . - -------- ----------------- ---- DATE -.rz3.'._L.3+Z .......------ BUILDINGPERMIT ISSUED ---------------------- -------------------------------- ----------- ------------- ------DATE -------------------------------- ---- COMMENTS------------- _-_ ----------------.-.----------------------------- -------------........................ -------------- --- --------------- .... ..................................................- ----------_-: 3+ : ....-. -. Finallnspectionby: ._.. . . - .- ------------------------------- ----------------------...Date _�.. I - - �, SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. SM