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FOR OFFICE USE: ' PPLICATION FOR SANITATION PE%,,J ' (Complete in Triplicate) Permit No. - - ... .-�. �� -[1" C/ ..._...---.__-______ ..__--_.-_-_--__-._ --- This Permit Expires 1 Year From Date Issued Date Issued 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 County Ordinance No. 549 and existing Rules and Regulations: 746 6 JOB ADDRESS/LOCATION .... — /Ca � u "it4wr�.°t7ENSUS TRACT _--------- -------------- �q �yy� -•- - �I may/ Owner's N �YJ ---_//l- -- -- - - ... -----eo--_---- - ------------/---.Phone .--------------------------- Address .--_./Sl/--_--- _ tytL120R-_C-1 Contractor's Name . r =S -------------- -------------------- -----...License --- Phone 4 K- 4 �-?A Installation will serve: Residence 05 Apartment House❑ Commercial ❑Trailer Court ❑ Motel ❑Other ---- -------------------------------------- Number of living units:----I------ Number of bedrooms -3-----.Garbage Grinder ?tV_-- Lot Size ..- ____________ Water Supply: Public System and name ------------------------— E�� Character of soil to a depth of 3 feet: Sand El Silt❑ Clay [Peat❑ Sandy Loam ❑ Clay Loam 0 Hardpan ❑ 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.) V NEW INSTALLATION: - (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [SEPTIC TANK j ] // Size---- -.�__'S/y9_x ,C_�__. Liquid Depth __.F_-- --__.--_----- Capacity � P��ctATypeNo. Compartments ..Z.............. Distance to nearest: Well ___--7p_R--------------- .....Foundation -1P_------------- Prop. Line .S.--__-.__._-... LEACHING LINE [� No. of Lines ----Z---_--_-__---_- Length �ee�ff�?wwach line_-2.�----_-___-- Total Length _� �.�____--_.__..- 'D' Box .✓ _ - Type Filter Material �YJOK -Depth Filter Material -_I _�-__-............._.......--.. Distance to nearest: Well _ 00'�----_--. Foundation -lP_---_-._--_--_ Property Line 6.-�_...._......_- SEEPAGE PIT [/�]� Depth -- �.----_. Diameter __32 Number __Z-_-------------__ Rock Filled Yes No Water Table Depth ......-- - ---- -------------------------_..Rock Size --------------------------- Distance to nearest: Well _-____----________________________Foundation -_._--------.-_.-_ Prop. Line -....._--.........._. 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 Ordirances, 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 ------- � _..- --------- -------- Title ...................... ...... ._ _.... .. __------..__..- (if other than owner) �I— e ` -�r FOR DEPARTMENT USE ONLY �y APPLICATION ACCEPTED By-----[----- --- ----- - - f---tp--t-d.--------------------..------------ DATE ------L9------ ------ BUILDING PERMIT ISSUED -------------- --------- DATE ADDITIONAL COMMENTS ----- - --- ------------------------------------------------- - - --------+----- - ---- - - ------ - - - --------------------------------DateFinal Inspection y LSAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M