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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT �Q (Complete in Triplicate) Permit No: � ._._. , .--- - - - -------�----•----.....--•--�--•--- This,permit Expires i Year From Date Issued Date issue �1Q. tt�� A plica ior° here made to thesan Joaquin Local Health District for a permit to construct and d install the work herein described- This application is made in compliance with County Ordinance No. 549 qpd exsfiling Rules and Regulations: JOB ADDRESS/LOCATION .__/7,30 t7 -------i�(_,........ _ ! _-ter -----_-•-- - S TRACT 1575-3.7-• --- i I Owner's Name P le.0,. o�� .t'!�� ''TQwP� ilk-1�14Z/��'ll��Phone..�rOg'_�DQ. Address . .. -----••............... ......................__••---............City ---------••----------------•----•-----------------•--•----------.......... Contractor's Name --------/110Ye/Q------------------------------------------------........License # ----------- Phone -------____-_-------• ` installation will serve: Residence❑Apartment House❑ Commercial Mrairer Court I] Motel ❑Other---------------------------------------- i Number of living units:_...2-- Number of bedrooms _____4/__Garbage Grinder ____ Lot Size _216 �-----/�C Water Supply: Public System and name _717wex------- ____________________Private❑ Character of soil to a depth of 3 feet: Sand 0 Silt K Clay ❑ Peat❑ Sandy Loam•❑ Clay Loam❑ Hardpan ❑ Adobe❑ Fill Material ------------ If yes,type__--_----------- ........ (Plot plan, showing size of lot, location of system in relation tc 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 f ] SEPTIC TANK i ] Size-----------------------------------.------------ Liquid Depth ._______________--- Capacity -------------------- Type -------------------- Material...................... No. Compartments ------------ ......... Distance to nearest: Well ____________________________________Foundation -----------------.... prop. Line................. LEACHING LINE [ ] No. of Lines ------------------------ Length of each line--------------•------------- Total Length .................... 'D' Box ------------ Type Filter Material ....................Depth Filter Material _-______•--...__- .......................... Distance to nearest: Well ------------------------ Foundation .._____......_.._-___. _ Property Line -------------------- ---- SEEPAGE PIT [ ] Depth ____---------------- Diameter ................ Number ............................ Rock Filled Yes ❑ No Water Table Depth --•-•----------------------------------........Rock Size ............................... Distance to nearest: Well ----------------------------------------Foundation .................... Prop. Line ----------_........... ; REPAIR/ADDITION(Prov. Sanitation Permit f •-------------••---------------------------- Date .................................. Septic Tank (Specify Requirements) •-•--•-•---------••--•-•----------------------•-•---- -----------•--• - •---___ - �i Disposal Field (Specify Requirements) ------4Z1.�G� Q - ID ---------•--- ---••--•-- •--•-•--- •-- w- ..................... ---------------------------------------------------------- --- (Draw existing and required addition on reverse side) 1 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 the performance of the work for which this permit is issued, I shall not employ any person in such manner as to become su ect fa W rkman's Compensation laws of California." 5igney _.._. • ~------------•-•-••-•------------•---•-•---------• - Owner By --- ��-------------------------------------------- --------------- ------------------ ------- Title --------------------------------------------------- -------------------- f, (If other than owner) F DEPARTMENT USE ONLY APPLICATION ACCEPTED BY .Q..�rt... .......... __-- ......-..........................-._........ DATE __-• -• •Z�'_-- _-• -••_-•-••-•- BUILDINGPERMIT ISSUED _-----•---•------ --------------------------•-----•----------- -------------••--•-------DATE .......................................... i ADDITIONAL COMMENTS ._.. - - ----------- ------------ ••-------------------•--••-•------•-••-----------•-•- --------•-----•----•----- -----••••--• ------------- ------------------------- •-•------------� Final Inspection by: .... __ _-•_ ...... ........... --•-••-----•-------••-__----------------_-•--•------•-----Date ..Z_=_.__ _'�l-.. SAN JOAQUIN LOCAL HEALTH-DISTRICT E. H. 9 1-'68 Rev. 5M a