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64.9 FOR OFFICE USE: APPLICATIONFORtSANITATION PERMIT 3a Permit No. (Complete in Triplicate) Date Issued --------------------------------------------------------- This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Health District for a per 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/LOClA-TI`ON �f -. CENSUS TRACT Owner's Name - _Wx�lcolf__-Yvloc��r------- --------- ------------------------------------ ------------------Phone -------- ----------------- Address -- _ Ic� __...------ ------ - Y � 1 Contractor's Name -----------License # .T.1973e-1,f _ Phone Installation will serve: /Residence ❑Apartment House❑ Commercial railer Court P❑ Motel ❑Other -------------------------------------------- Number of living units_____________ Number of bedrooms ____________Garbage Grinder ------------ Lot Size ._19-6;�n �d - Water Supply: Public System and name --------------------------------------------------------------------------------------------------------------Privat Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Gay ❑ Peat ❑ Sandy Loam ❑ Clay Loam.E] Hardpan ❑ Adobe;< 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.) NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK f ] Size-----------------------------------•------------ Liquid Depth ----------_--------------- 0 r�7._r pu� Capacity ----- --<- --------- Type ---- --------------- Material---------------------- No. Compartments ------•--------------- T Distance to nearest. Well -----------------------------------.Foundation ---------------------- Prop. Line _____________________ LEACHING LINE No. of Lines - [ ] -___,-.!______________ Length of Bach line--.��--------- - -- Total Length ---��---••-•----...__ . � tr 6� r5 7,14;1 D' Box (;�c-___ Type f=ilter Material 1,t1�_ Z.-___Depth Filter Material ___ __________________ __________ 11 0, Distance to nearest: Well __/�__T`____ Foundation __/0____ __.__ Property Line. --�!VL ______________ SEEPAGE PIT Depth _ __ -------1------ 4 [ � p __ ___ Diameter _�� __-_ Number -- Rock Yes No i❑ ' r Water Table Depth __-� -------------------------------------Rock Size -- Distance to nearest: Well __.�Qp_____ __________________Foundation __ l3._________ Prop. Line REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date -__-______________________________} Septic Tank (Specify Requirements) ----------------- --------------------------------------- -------------- Disposal Field (Specify Requirements) ----- -- r ° -------`00 `-'--� ------�./ ----- ------------ ------------------------ --------- ------------ ------ ----------------------------------------------------------------------- (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. I 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 becomct toor man's ompen ation laws of California." Signed _ caner BY -- --- - 3 Title ----------------------------- {If other than o FOR DEPARTMEINT USE,,O APPLICATION ACCEPTED BY r' ------- ``'� -------------------- DATE ---- ` ------------------- BUILDING PERMIT ISSUED - ---- ------------- - ' --------------------------------------DATE ----------- -------------------------------- ADDITIONALCOMMENTS ---------- ---------------------------------- --------------------------•---------------- --------------------------------------------------- ------- -------- - -- --------------------------------------------------------------------------------------------------------- - ------------- T Inspection by: Date �-f Gam' 1/ --------- FinalSAN JOAQUI LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M