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i FOR OFFICE USE: 'APPLICATION FO : SANITATION PERMIT Permit No. -------------------------------------------------- (Complete in Triplicate) ----------------------------------.- Date Issued �---7- - This Permit Expires 1 Year From Date Issued 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/LOCATION:---- � C /t� L -----CENSUS TRACT Owners Name _ f--------/A-C�-� �-------------------------------- - PhoneJt • ----------------------- ------- City ---51710e_ -1 /-------------------------------- Address - --��1!/1�=--- :'----�------------ ----- - --- - - Contractor's Name tl- �--------------= License # 17 Phone1'-___' a _7. Installation will serve: Residence IR Apartment House Commercial ❑Trailer Court ;❑ Motel ❑Other ------------ ----------------------• _ Number of living units:----j------ Number of bedrooms 0-----Gorbage Grinder .1V0__ Lot Size .__ ---�La------- Water Supply: Public System and name ------------------------ --------------- -------------------------------------------- Private t Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat ❑ Sandy Loam ❑ Clay Loam ❑ Hardpan ❑ AdobeX 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.) I NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK / Size:9a_�_ '< --------------------- Liquid Depth ___ —-------------.--- ,/ . Capacity _1400,----_ Type f�,`C i_'"Material ZA,J/e, /Q— . Compartments __ __ _______________ Distance to,-'nearest: Well -- , -- ---------------------Foundatioonrn ___ D-__`_________ Prop. Line __��____�_____....-- r LEACHING LINE [�Q No. of Lines .__2-_____________ Length of each line r_. .. .&5-------------- Total Length - 71..x.---•------•- I D' Box -----A____ Type Filter Material /_�__---- ---Depth Filter Material --- ---- ------------ _I Distance to nearest: Well ----L5�-___----- Foundation -___ P- Property Line -- ---------------- SEEPAGE PIT Depth ~--- Diameter ,�.�------ Number s__________ _____ Rock Filled Yes No ❑ ie Water Table Dep#h ----- ------------------------------Rock Size J ---------- Distance to nearest: Welll------------------------Foundation ______------------ Prop. Line = .�_-__--..- REPAIR/ADDITION(Prev, Sanitation Permit# -------------------------------------------- Date _____________-.------•------------) Septic Tank (Specify Requirements) ------------- ------- ------------------ --------------------------------------------------------------------------•-- Disposal Field (Specifyi Requirements) ------------- - - ------------------------------------"--------------- .i ------------- --------------------------- --------------------- ------------------------ ------------------------------------------------------------------------------------------------------- --------- (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 Sate Joaquin County Ordinances, Siate'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 I as to become subject to Workman's Compensation laws of California." Signed --- ---------------`-- ----------- ----------- ---------- ---------- Owner Ael BY t-. Le - _ Tit (If other t�l., owner) FOR DEPARTMENT USE ONLY ` APPLICATION ACCEPTED BY DATE -- BUILDING PERMIT ISSUED -------------------------- -- ---------------- DATE ---------------------- --------------- ADDITIONAL COMMENTS ---------------- -------------------------------- ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- -------------------------------------------------------------------------•---------- -------------•- -------- ------------ Final Inspection b Date :_-_._6{ -------------------------------------------------------- -------------- p Y: ------- = ----------------- ---- -77 JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M