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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT _A _'��=L_.---- ��',--'�--�--------- - (Complete in Triplicate) Permit No. --------- --------------------------------------------- Date Issued ---&,/.'a"__.6 _ ---------------- This Permit Expires 1 Year,f rom 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/LOCATIO Cts &Z� ^o ------------ ----CENSUS TRACT -------------------------- Owner's Name --------- vL ----------- -------Phone ------ ---------------- -•--------- -- ----- ---- - Address -------� -------------- ---- --- ------------------------------------------. Cit sT�c/---- ----------------------------------- ... Contractors Name . . _ e__s �/- ii,g� _. s�2y�e -----------------------License # ---------:---------- --- Phone ----------------- Installation will serve. f Residence XApartment House❑ Commercial ❑Trailer Court i❑ - Motel ❑Other -------------------------------------------- I' Number of living units:---!------- Number of bedrooms _,2------ (Ader ._-__._.._ Lot Size 1-.�4,e7--_------ -- ---�-- Water Su ly: Public System and name -__-_____ cr tA.- -----=------ -Private ❑ Character of soil to a depth of 3 feet: Sand'❑ Silt Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam:❑ Hardpan ❑ Adobe-X Fill Material ------------ If yes,type -------_�'_'--------------- (Plot __-#.-__(Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) e NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ J SEPTIC TANK'[ Size- --l�_ --- --la_ - '----__---- 01 Liquid bepth �________ ______ Capacity �_ ,_Q�------ Type��e ----- Material No. Compartments _- -...:4 Distance to nearest: Well __'j`j0-tAF-------------------F undation ..__ --------- Prop. Line/_ _--_-_.--- e LEACH WG LINE No. of Lanes -_�_.________________ Length 4feach line-__rQ.___ ----------- Total Length ----- 'D' Box ___Tin.... Type Filter Materiai s {Depth Filter Material _l ° ------------------------------. Distance to nearest: Well _��®_N Foun anon-.___- Property Line -------6_._.___:____ SEEPAGE PIT Depth ---2,7------- Diameter , 'Y}. _-_ __'Number _.___ ------------------ Rock(Filled Yes No ❑, Water Table Depth --�a---------------------------•------- Rock Size __1 �_- .- t : t � Distance to nearest: Well -------- $_hl --------------Foundation _ __.___0------- Prop. Line ------ ---------- REPAIRfADDITION(Prev. Sanitation Permit# ------.------------------------------------- Date r------------------- ------------} Septic Tank (Specify Requirements) --------------------------------------- ------------,------------------------`--- --------- ---------------------------- f �-I I Disposa! Fie (Speci y equirements ------------ -------------- -� ---------- -- ----- -------------- ----------------------- J A (Draw existing and required addition on reverse side) I hereby certify that I have prepared this application and that the work will he 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 "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 ublplokto Workman's Compensation laws of California." Signed Y i /�7�.�) � f �� ! By ------------------------------------------------ ------ ---- �-1 �4- - ---------- -Title -------------- ---5------------------------------------------ (If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY -----------. DATE ---/-13--6 - --- BUILDINGPERMIT ISSUED --------------------------------------------------------------------------------------------------- DATE ---------------------------------------- AUNALJO�MM T --- ----- ---- ---- --- ` '9�' - ---- - ------------------------------------------------- ---- -- - i Final Inspection by. < - ---------------------- Date - SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M