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Y FOR OFFICE USP APPLICATION FOR SANITATION PERMIT ...................------------ (Complete in Triplicate) Permit No: -� ----'--- '----------- ---------- C ............. _..,,,-,,.,-„ ,,,,--.,.,._.,............. This Permit Expires 1 Year From Date Issued Date Issued „ Application is hereby made to the San oaquin Local Health District for a permit to construct and ijnstall the work herein described, This application is made in mpliance with County Ordinance No. 549 and existing Rules and Regulations: fit JOB ADDRESS/LOCATION -i. A-- -- - -7rJ -- --?+ --------------.®1V-- ---- - --CENSUS TRACT ...w�a .- .. /� Aaa Owner's NameJIY- l. __ LLL_�_lY.rr-'.�-._ - Pho - �r , e p Address -- - Q 4-:.. Q ... �../..7�- �---'-,',-"�'r-'---"-- _. City . . Q/Y -----.--------- - ../^ y' --”----- Contractor's Name - _ _ `s __.._..license#&'�..��--- Phone 4003 1. Installation will serve: Residence.❑Apartment House[] Commercial:❑Tr ilea Court 0 I a i r � :t- - Motel ❑Other.. -_...-. _.-.- i r - Number of living units:._..__.__ Number of bedrooms ......... Gar, €,Grinder ._..-...... Lot Size .. ... ------- .__-._.r._._ P'.... t r Water Supply: Public System and name .. ..rl- .-___._____-----I-------- . . ..__---- ;_. _ ., . .._._..].-.__.._...Privatel,!� Character of soil to a depth of 3 feet. k,San8A., Silt n Clay ❑ t Peat❑ Sandy Loam ❑ Clay Loam ❑ r � _ .=�''' ,;�-.c,:,r � „ a •'- -� r Hardpan ❑ Frll M�t Hal .._ If yes, type--------- Adobe (Plot'plan, showing size of lot, location tsystem in relation to well , buildings, etc, must be picked on reverse side.) NEW INSTALLATION: r(No septic;tank-or„seepage pit permitted if public sewer is available within 200 feet,)_ r r �% _. PACKAGE TREATMENT �j SEPTIC TANK Size_ _D.�� --.------- Liquid. Depth" _�_...._,- _ ._ i I I Capacitv2p- ......_ Type.. 4.�kc_ Moteri -. _ __ No. Compartments _..Z . .,-... ' � r � Distance to nearest: Well .'� ..............'r^.,.....Fouur�r/iic/la77tion 1:0............ Prop. Line`.. __.-.,..._- LEACHING LINE No. of.Lines ..f_. __________. Length of/`eac li rr __.ji.(1_r............. Total Legri9/ ----D--Q!f- 'D' Box pe Filter Materialr�(.�. ./ fr... epth Finiter Material .J _........ .�-j.--`. ...- Distance to nearest: Well �-6�J.--_""_'Foundation ../.<1............... Property6 Line SEEPAGE PIT [ j Depth Diameter Number ............................ Rock?Fill-e`d Yes ❑ i No ❑ t Water Tr able Depth ................................................Rock Size ......................... Distance to nearest: Well ---------------------------------Foundation ..................... WOpLid .... ........ \ i REPAIR/ADDMOW(Prev. Sanitation Permit# ------- ......... Date ...-_...................__------); ,&gptic Tank.(Specify Requirementsl.-=--. _x-1----------------_--- -- -- --...-...'----'-------------�------'----"-•-'--'----'--'-"------t-- --------- -- --------- ' Disposal Field (Specify RequiremenA)- - --------------- ------------------------------------------..__------------------„------ --- .....' ................... ..........................'' ------ ------------------------------------------------------------ -- ----. .............._.. ---------------------------------------:....`r'-- - G ------------- ----------- ''-- ------ ---------e....' '-” ..........:-. _.. _........'-''•-:..-..-._._ (Draw existing and required addition on reverse side) t I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County Ordinances, $fate Laws, and Rules and Regulations of the San Joaquin Local Health District. Home owneriot licen- sed agents signature certifies the following: "I certify that * the performance of the which this permit is issued, I shall not employ any person in such manner as to became su ject to War an' Com�ensation laws of,California." . Signe . .. . ... ..... _ _...._ ---------11---- ._._ Owne.L . By- ----- - ._..__ ..... Tit e, f other than owner) `J FOR DEPAATMENT�USE ONLY APPLICATION ACCEPTED BY--- -------- -------------- ................. -------- --- -------- DATE - -- ----- ...DATE BUILDING PERMIT ISSUED ---...-T'---------- ---------------------------- ....... ..... - -- -- ADDITIONAL COMMENTS - - - ' - ---- ...:.. --------- ---------" - ------------------- "' .....-.... -------------- -` - - - - - " - '/ -------- --- - - --------------------- ' - ... . .... ..............-- ----'--'--'---...1.... - ..- ----_...- -'-- - -- Final Inspectio .- : '._-, ^•7i-llf --. -.--_ ---- - - -. -:�a`....................--'-_Date --'- "-'"--- r--�f's""•-`-"' • SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M