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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT w __ _ -L:, d-- Permit No: (Complete in Triplicate) This Permit Expires 1 Year From Date Issued Date Issued ----------------- ------------------ -- Application is hereby made to the San oaquin 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 .-- ---- J-- ------CENSUS TRACT -------------------------- /� 10 Owner's Name --- -C..----�-r-----�---.�t�GG4141"0 &r�.f��----------------��z'=--=----------------- Phone --- -- Address 0 -zz, zew4e ----------------------------------. City��C ---- �r ---------- Contractor's Name .-_ ---------------.License # -r • 1U-- Phone Installation will serve: Residence ❑Apartment House-[] Commercialrailer Court i❑ Motel ❑Other __. ---—------------I----- Number -------------------- Number of living units------------- Number of bedrooms ------------Garbage Grinder ------------ Lot Size -----1p-1;&— ` -5---`- --- Water Supply: Public System and name --------- -----------------------------------------------------Private)< i liP Character of soil to a depth of 3 feet. Sand'[] Silt❑ Clay ❑ Peat ❑ Sandy Loam ❑ Clay Loam,E] 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.) NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ } SEPTIC TANK'[ ] Size-----la---X_40 ----l-Q----------- Liquid Depth -------.----- Capacity _1_200----- Type -------------------- Material--� No. Compartments _--_ --_---_-- Distance to nearest: Well ------4910......... ------Foundation _Cd-----_----_--_ Prop. Line __.S7------------- i LEACHING LINE [ ] No.j of Lines :---_- -------------Length of each line-------IV--------.------ Total Length --..../_ .Q-___-.-.--_ � r 'D' Box r"__ .Type Filter Material f _X_ _ --Depth Filter'Material ---/d�------------------- ------------- Distance to nearest: Well ---LoQ,r-'-------- Foundation ----�-----.___f'--'Property Line - -------------------- SEEPAGE PIT [ ] Depth ---- ____ Diameter __S_�,-.---_ Number ____-_-- _-_--_.1�__' Rock Filled Yes No i❑ i I Water Table Depth -----,� --------------------------------Rock Size "" `----- I w Distance to nearest: Well ------1 -----------------------Foundation _/Q'--.------ Propi Line _-�_.....--..-- --- REPAIR/ADDITION(Prev. Sanitation Permit=# ---------.--___._""_-_----------- Date -- -------------- ----------- �;� Septic Tank (Specify Requirements) --------- ------- ---------------------------------------- Disposal Field (Specify Requirements) ----------------------------------------------------------- ------------------------------------- ----------------------------- - -------------------------------------------=-------- --------------------=- ---------•-------------- -- ---------- -------------------------------------------------------- --- =----------------------------- ¢ (Draw existing and required addition 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: .y "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 beco bject to Workman's C mpensation laws of California." Signed --. -.-_ Aothe -----. Owner ------ -Tit) /. --------- -------------------- ---------------------------- {[ an owner) DEPARTMENT USE ONLY APPLICATIONACCEPTED BY -- -- ------------------------------------------------------------- DATE ---- - - ------------------ BUILDINGPERMIT ISSUED ------ -------------------------------------------------=--------------DATE ----------------- -------------------.---- ADDITION—AL COMM. T- ----- - - ---- - --- - - ----- ----------------------•---------------------------------------------- ----------------------- --------------- - ----------_-----------------------------------_-----------------_---------------------- -------- ----------------------------- _ _ ----------- - - - --------------_------ -- --------- _- Inspection by: -___-. ----.Date -- --'---f r - ----------- Final ' JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 I-'6B R . 5M _ ��