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FOR OFFICE USE: F ' APPLICATION FOR SANITATION PERMIT (Complete in Triplicate) Permit No.7o---7 r P p ---------------------------------------------------------- Issued/ �a__/t�.7 .--_-.._------------------------------------------------ This Permit Expires 1 Year From Date issued Date CJ 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 Ordinanc o. 549 and existing Rules and Regulations: 106 ADQRESS/LOCATI ---1'l9 -- fia 7" mo- ----'------ ----------- ------CENSUS TRACT ------ ---6----------y Owner's Name __.- Q Phone --- ------ -_ �'.`J"`_ �� ---- ------- ------------ Ply i --------------- Address Contractor's rNa�e�_ � `v�1�-- ��'�--��.�-----r��;----- --•--. CitY ---,�/`�--ti--------•------------- -- ----------•.__._.._....--- . t ----.License Phone Installation will serve: Residence ❑ Apartment House[] Commercial {NTrailer Court ',0 Motel ❑ Other ------------------ ------------------------- Number of living units------------- Number of bedrooms ------------Gc,rrbage Grinder ------------ Lot Size ---la-�_J---__ _8- -------------- Water Supply. Public System and name ------------------ --------------------------------------------------------------------------------------------Private Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay, ❑ Peat❑ Sandy Loam ❑ Clay.Loam 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 Oilable within 200 feet,) PACKAGE TREATMENT SEPTIC TANK Size_ q ------ P,_.________ Li uid Depth ---._- r - Capacity/-)-,.40-_--a/�ype% P--f—P 37 Material_- -'G®'L- No. Compartments � Distance to nearest: Wel! ____________________________________Foundation _ ----AU---------- Prop. Line ....... t LEACHING LINE [ No. of Lines ________�_----------_ Length of'each line.n_-__ _%_ -----.--- Total Length ----%_ .............. 17 �' D' Box --___ Type Filter Material ____,/1_/`__ __.Depth Filter Material __.___ _______________________________ ) Distance to `nearest: Well--------------------------- Foundation ------------------------ Property Line -----------______._._.___ 1 SEEPAGE PIT VT Depth _____:___ Diameter ..._.� _____ Number .-----. _ _ _ Rock Filled Yes No Water Table Depth ________a_ �1-1_______-- -, --____--._Rack Size ------ -�Cl�---------------- P v� 1 Distance to nearest: Well -------------------------- -------------Foundation _,4�U__________. Prop. Line ------- REPAIR/ADDITION ______REPAIRf ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date ----------------------------------) Septic Tank (Specify Requirements) ------------------------------- ----------------------------------------------------------------------•--------.,--------- Disposal Field (Specify Requirements) ----------- ------------------------------------------------------------------------------------------------------------ ----------------------------------------------------------- -------------------------------------------;------------------------------------------------------- ----------------------------- ------ (Draw existing and required eiddition on reverse side) ; I 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: ,�T "I certify that in the performance of the work for which this perr;nit is issued, I shall not employ any person in such manner as to becomesu t Work 's Compensation laws of California." Signed ----____-- ----------------------------------------------- Owner BY ----------------------------------------------------------------------------- Title ------------------- (If other than owner) OR itTMEN7 USE ONLY APPLICATION ACCEPTED BY ----- ------- ----- ----------------- DATE -/ -------- s BUILDINGPERMIT ISSUED --------- - ----- ---- - ----- - ------ - ---------- ---------------------------------------------DATE ------------------------------------------ ADDITIONAL COM EKITS ----I --- - ---- f�-'��i- 6 r-/ ---------------------------------------------------------------------------------------- - ------------------------------------------ - - - ---- - - ------- --- - �li'%7yal Inspection b .___Date _._.�f___�� CGpyr �rc.&k V t} ie SAN OAQUIN LOCAL' HEALTH DISTRICT E. H. 9 1 '68 M