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FOR OFF. E USE: Ltl� APPLICATION FOR SANITATION PERMIT .-...-.... (Complete In Triplicate) Permit No. ..- --- - --------• - -- ----d -.-..... This Permit Expires I Year From Date issued Date Issued .- 1� 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/LOCATIO �L( ' ----.----CENSUS TRACT ...--._----.-.-•----_-,- Owner's Name ...----5..> ..-w.l.4....-tia:.�•----- {- ��a�4G •-----r.._...._..-. hone .. /..-.'? 3 �r Address - - - ' ��----�- - -- - '�'-•--� "�-�---•_ - . --- ----- --- Contractor's Name ----- - - .N..! :z«.e. ---.- -•--.-_....License# !!,7.'�i��1-- Phone �'. 3O•� Installation will serve: Residence OEApartment House❑ Commercial❑Trailer Court 0 / Motel ❑Other.---------- - .-_._.............- Number of living units:...-.Jr--.. Number of bedr`o�c s ...4X...Garbage Grinder ............ Lot Size - .i qd Water Supply: Public System and name .............X - (,M...:-�%c:'�------ -----------------.................Private❑ Character of soil to a depth of 3 feet: Sand 0 Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam 0 Hardpan❑ Adobe 05 Fill Material -_-__ If yes,type....--...__--------------- Mot 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 if public sewer is available'within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK Of. Size k _...... Liquid Depth -/.om Capacity/,20_ l ;;Type No. Compartments ---2.-............... - 00 Distance to nearest: Well .-•.. / / - �----••--•----.-.-.-.Foundation --,C.-Q....._.-.- Prop. Line.... Z LEACHING LINE )<L,- No. of Lines a ---- - Length of each ne--..-------�,L`....... Total Length -._ rr--------------_- • Depth Filter Material �� 'D' Box ----�--.-- Type Filter Material -_�--.. . . .. „��'-- ------_- V ' r Distance to nearest: Wall ..-ae�i:Q-.--.------. Foundation -..10.---..--.--- Property Line .--4�,-�-----•-.. SEEPAGE PIT Depth -.o ,S .... Diameter .:;Z --eNumber ........Z__........... Rock Filled Yes L�' No ❑ to Water Table Depth _---__,2Q..............................Rock Size ..... i Distance to nearest: Well -----1A0_ '-----,----•----Foundation .-.f- ....... Prop. Line ....... REPAIR/ADDITION(Prev. Sanitation Permit# ..........................-................- Date --- --------- ---------- Septic Tank (Specify Requirements).....................................................- -- Disposal Field (Specify Requirements) ............... - - -------------------------------------------------------------- .......--------------------------------------------------------------_.------...-.......---.._....--..-..-.....- s raw existing and required addition on reverse side) 1 hereby certify that 1 have prepared this application and that the work will he 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, 1 shall net employ any person In such manner as to ecome _ ct orLkman's Com ensatlo_ laws of California." Signed ------- wOw ner B � ---- wother than oer Title .......... n' FO D PARTMENT USE Or4LY APPLICATION ACCEPTED BY--.. ...... ..-.. .... _-- -..-.. - - DATE--..--..� -.?-. BUILDING PERMIT ISSUED -.--.-.-__-__---, --___-._, -DATE ........ ----------------COMMENTS ------------ ---- - - ---- - _ '-------- ---- --� __ ... - ---- ----- - ------- - -- .t ib::" - . : f..... ---- --- ----------::::: .. ... --- ----------------------- te- - Final Inspection by: -. .-- - - //• - - - - -' - - ------ -- Da ..7.��.2; 7 SAN - .--.- .-.�.-.Zc(Ctf... -. - -`-------------'--- SAN JOAQUIN LOCAL HEALTH DISTRICT \ E. H. 9 1-'68 Rev. 5M