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,y APPLICATION FOR SANITATION PERMIT --------------------....--...-F-- -----`------ . J/ �. (Complete in Triplicate) No. ..7/-- plicate) .r This Permit Expires I Year From Date Issued Date Issued ..� c/1121 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: JOB ADDRESS/LOCATI N _��Q_...SO. ._ /1�� - -- - - -CENSUS TRACT q --- Owner's Name -..-- a2' -- G - ----- --- ------ --- -_,...- ----------Phone �l.-Z% Address ;P1*10 r - -- - -- ----- .... City WA9,9 -- --- -- ---- Contractor's Name -b�..�� G _--,5_,ew,----- .License #//, ?7$W� Phone .� "'ti .✓!� Installation will serve: Residence Apartment House❑ Commercial ❑Trailer Court ❑ Motel ❑Other ._ - -- ------- - - --------- �y Number of living units:...,/._.. Number of bedrooms -----Garbage Grinder _W4P Lot Size _/V~-- -------- Water Supply: Public System and name ----------------------------------- -----------------------Private ❑ Character of soil to a depth of 3 feet: Sand E] Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam [] Hardpan ❑ AdobeA 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.) Q NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ I SEPTIC TANK oplo _ Size_ yt� �1��--.-.----- Liquid Depth r ��_----------- . IF Capacity Type MateriNo. Compartments __............. f / Distance to nearest: Wel ...Y_® _.._..----.-_-._..Foundation ..._.. ----- Prop. Line , �_.--_--.-._. di LEACHING LINE ,� No. of Lines ..... Length Length of each line__._5. ...._____. Total Length -leo-----------_-- 'D' ..............'D' Bo .. Type Filler Material p -------------------- De th Filter Material .. __...___-.---_.- Distan a to nearest: Well ------------____-�_ Foundation ________...__ Property Line _...................... SEEPAGE PIT ,� Depth ,27-------____ Diameter - ----- --- Number ..... ____ _ dock Filled YeLC No 0 Water Table Depth _-.30e,----------�----_ - - _----Rock Size --� .1�.--..------ -- / F 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 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 t e performance of the work for which this permit is issued, I shall not employ any person in such manner as to becomes ct to W r an' mpensation laws of California." Signe/Or' -------- - ------- ---------------------------------------------- Owner r an we :OVr) --- - - Title ... - s FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ----- - - -- --- --------- -- ---------------- --------- DATE . BUILDING PERMIT ISSUED _ _. ----- .......... .._...._.- ------------------------------------------------------- ADDITIONAL COMMENTS .. . . ..... ---- -- -- --- ---- - - -------------- ---------------- ---- - --- ------------------- -- 7O - - Final Inspection by: ---- -----....------------Date ..---- ',r ��------------ ... SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'66 Rev. 5M C�