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FOR OFFICE USE: I APPLICATION FOR SANITATION PEI,,,,,T (Complete in Triplicate) Permit No. .. .:L..=c�i�rl. ------ 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 pp p�_�/ S0 y , �o n j�1o. 549 and existing I and Regulations: Owner's NaSmeLOCATION 1lfC, GfGiC / J' %/Id /1y.._..EIGS TRACT - - described. This application is made in compliance with Coun rdi j JOB --- - �a-/`L�& V . �/� [ ------- ---.-Phone ----------- - - ......... .. Address ---_.... _Rf 4- ��- - V?.......... --�/w�kr-cl ---- - City --4,0--rult--------------- - - -----------------_......------------. Contractor's Name '(?- -/ - - - - - .License #L a`Ir Phone Vls-;� ._ _ _ `� Installation will serve: Residence;K Apartment House❑ Commercial❑Trailer Court ❑ Motel ❑Other -- - ._... -...... - Number of living units:... Number of bedrooms .....Garbage Grinder AIV---. Lot Size ........... Water Supply: Public System and name -------------M----------------------------------------------------------------------------------Private [{4� Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam 0 Hardpan � Adobe E] 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,) 4 PACKAGE TREATMENT [ ] SEPTIC TANK tam Size ---------------- Liquid Depth ....___.__.._. Capacity 1 4.10,0 Type/ No. Compartments _y' -:_._ -.- T Distance to nearest: Well .....e✓_pe.y______.__.____Foundation ../ --------- Prop. Line Z_3_'._ _..-._- LEACHING LINE (g No. of Lines .... ------ Length of each line._/lda Total Length _Z1 .._.._.__. 'D' Box .Il l.. Type Filter Material /41/_&eL/,1bepth Filter Material ---------............ .-..-_ Distance to nearest: Well ...... Foundation ..%,?.`_�-.____ Property Line _.,CCt_�__........ SEEPAGE PIT [4- Depth _>_M4.-_�. Diameter 7 �r_._ Number ____ Z-_.--------- --- Rock Filled Yes J9 No ❑ Water Table Depth -----------------------Rock Size -�-'`t---"5•-,•--------- —_. r � Distance to nearest: Well _.__f ___._-------- ._---Foundation __. 11....._- Prop. Line .-Ae ........ 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 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: "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 --------•- --------- ------- Title - --- Owner By ----------------- r Title ------ ---------------------------------- (If er than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY - - -' ' -'----------------- DATE ------------------------- BUILDING PERMIT ISSUED ------------------- - I------------------ --- _M------ -----------'---------DATE ADDITIONAL COMMENTS ------------m--------- ----------- --------MM---------M----M---_ ------- --------------------------------------------- --------'------ ---------------------------- ------------------ - - ---------------------------------------------... --------------------------------------------- -- - ---------- - - --- ---------------------------- -- - .._.. - ---------------_---------------- --------- ------------.._.. ---------------- -- ..... b Y ✓ 17 y,�2'✓ - - - - ------- ate - - D ......... Final Inspection 6 SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M