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FOR OFFICE USE: 4 APPLICATION FOR SANITATION I'ERIIAI'� ' -----------------------------------•--------------� 7 (Complete in Triplicate) Permit No. _ --------------------------------------------------------- This Permit Expires 1 Year From Date Issued 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�p.__-__�!__,C_�- :___W-------- PO N1 Qf{.).--------._CENSUS TRACT _ _-5�------- Owner's Name [b? . . -CENSUS vTE-�e�-----------• --------------------------------------------------------Phone ----------------11 Addrass ----- , _----W-------RIPQ ------ -P------- Ci Contractor's Name !�_ 1 : ---------------License # ------------------------ Phone Installation will serve: Residence ❑Apartment House,0 Commercial❑Trailer Court 10 Mote'I-ElOther-------------------------------------------- Number -------------- -------------- ----- - - Number of living units_____________ Number of bedrooms ___ Garbo a Grinder r~ ------- 9 �c7--- Lot Siie ----�CRcr}�z�-•--•-----•- Water Supply: Public System and name ________________ ________ //____ Private - , Character of soil to a depth of 3 feet: Sand' Silt' Cla ❑ ❑ Y ❑ Peat❑ Sandy Loam Clay Loam ❑ �- Hardpan ❑ Adobe ❑ Fill Material _ -_ If yes,type ---------------------------- (Plot ______________________ ___(Plot plan, showing size of lot, location of system in relation to wells, buildings, 'etc. must$e-placed on reverse side.) NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is.available within 200 feet,) PACKAGE TREATMENT f ] SEPTIC TANK' [ l Size1 -------- Liquid Depth Capacity -----------------•-- T -------------------- a Ype Material-------------F-- ------ Na Compartments --=-------------� � i Distance to--ni arest-. Well __ ____ __ ---------Founda-tion' LEACHI i [ j No. of Lines 'Length-Lew each line LINE r. , - ------ Total Length -------------------- 1 'D' Box __J--------- Type Filter Material ----------?____-_.__Depth Filter Material ______________�--------------------------------- I ____._. _____.._._ _ i k ! Distance toynearest: Well ------------------------ Fdunddti6n—_______-- _-_-_- PFcperty-"L& -= ' ---------------- SEEPAGE PIT [ ] Depth .__'_'------------ Diameter; j ---------------- Number Number ---------------------------- Rock Filled Yes '❑ -No ❑ Water Table Depth ------- --------- - - -----Rock Size ----------------------- t } t Distance to nearest: Well ------------------- ---------------------Foundation -------------------- Prop. Line._-----------,--------- REPAIR/ADDITION(Prev. Sanitation Permit# ------ --------------------- --------------- Date ------------------•------_-__-- Septic Tank (Specify Requirements) ----------------�`-_----------------_-- --•----------------------------- - ----------------------- ' Disposal Field (Specify Requirements) -____ Q QfS '----- -DX-- -----------OR--------�J _ ----- _C - ---------- _ ------ -------------4n,01F--------�-------- STS --- -------Sy5_771E_r1,j '--------------------------------------------------------- F----------- '--------- --------------- f --=---------------------------- '--------------- -- --------------------------- ------------------------------- --------------- .' (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 Sr(n Joaquin County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner or liven- ' sed agents;signature certifies the following: ' . 2 ; "I certify that-'ih the performance of,the work for which this permit is issued, I shall not employ any person in soth manner as to becomes t to man's Compensation laws of California." Signed ------i--- - _ , ----------------------------- --------- Owner By � -� Title `t (if other than owner) ------------------------ I { FOR DEPARTMENT USE ONLY ' APPLICATION ACCEPTED BY r R-Q---------------- DATE -- :__ �- 6 BUILDING"`PERNIIT-ISSUED --- ----- ----- - ----- ------�.---=-�-- -----------=---------- ----=------- -`��=--�`DAT� - ----- ---�"�`'.-/ ADDITIONAL COMMENTS ----____ ,---Ct-� -3'^- ' ' i . .. - - ----------------------- ---------------------------------4- ------------------------------------ -- - ------a --- - - ------ ------------------------------------ -------------------------- ----- SAN Finallnspecti b r = --Date ----- - -- Z _ {- SAN JOAQUIN LOCAL HEALTH DISTRICT / E. H. 9 1-'66 Rev. 5M