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A.F fF :O CE USE: Ln7� APPLICATION FOR: 5ANITATION PERMIT .ei r oil /.�, � - '� (Complete in Triplicate) Permit No. ____.__ _ t 4 ' ' . 9 -------- 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 O�inc:,:reNo. 549 and existing Rules and Regulations. JOB ADDRESS/LOCATION __ --_.___ULA//-1 ________ --�-�-----------------.._.CENSUS TRACT ------ Owner's Name ._ 1T ------ -=---------------- `�J ----� --Phone Address a .L �¢� �� City. G Y --- - `-- -----------/--- - ---------.License # la- a a Phone--- -- /-1�- Contractors Name _.___._ __ _______ / �� ! Installation will serve: Residence [Apartment House❑ Commercial ❑Trailer Court ',❑' Motel ❑Other -- -------- ------------------------ Number of living units:----- Number of bedrooms _ Y----Garbage Grinder,'-_ Lot Size _ ------- Water Supply: Public System and name -------------------------------•----------------------------- -------------------------------------- Private Character of soil to a depth of 3 feet.. Sand,I❑ Silt❑ Clay ❑ Peat ❑ Sandy Loam -❑ Clay Loam ❑. I Hardpan ❑ Adobe y Fill Material _�r11_d_ 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 septictankor seepage pit permitted if public sewer is avoiloble within 200 feet,] F I � 1/� PACKAGE TREATMENT [ I SEPTIC TANK , ` ize_____y_ _ _ Liquid Dept "T �� ---- q P Capacity- '7-_____ Type -Rwd&4_Material 1--+�C_ro. Compartments --- 0 Distance to nearest: Wel! ------- __________________Foundation/Q------------'__ Prop. Line ---- LEACHING LINE �[;►� No. of Lines __ ---------- Length of each line___ _ ry _ __ Total Length ,Af J _______________l } f 'D' Box .;-/ 5-- Type Filter Material /_�i�____!'_Depth Filter Material __,� _.�_------_----------- ._.__._.____ ' Distance o nearest: Well ------ --------- Foundation __ > _____________ Property Line. ______-_------ SEEPAGE PIT [ Depth r _ ______ Diameter -, ��--------- Number _'_.-- DL .:_________-Rock Filled Yes No 0 Water Table Depth -------_i.� Rock Size - -� -_-` 2-- �- ----------------------------- - Distance to nearest: Well --------� �__ ------------------Foundation f Prop. Line __ _.._:___._.__ G REPAIR/ADDITION(Prev. Sanitation Permit# ----------------- -------------------------- Date ----------------------------------] SepticTank (Specify Requirements) -------------------------------------------------------------------------------------------------------------------------------------------- Disposal Field (Specify Requirements) --------- -.--------------------------------------------- ------------------------------ -------------------------------------------- ------------ -------------------------------------------I-------------------------------------------------------------------------------------_------------------------ ---------------------------------- (Draw existing and required addition on reverse•side) I hereby certify that I have prepared this application and that the work will 'be dohe\in accordance with San Joaquin County Ordinances, State Laws, aind Rules and Regulations of the San Joaquin Local Health District. Home owner or licen- 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 become subject to Workman's Compensation laws of California." ' ------------ Owner ` Signed ----------------- = .. ~ OZ� Title ------------------------------ By --. ----------------- (fes - - ----------' (If other- an owned � f O EPARTMENT USE ONLY •� !f� APPLICATION ACCEPTED BY ------- - ----- r - - -- --------------------------------------------------------- DATE --- BUILDING -BUILDING PERMIT ISSUED --------- - --------------------------------- ---------------------------DATE _------------------- ADDITIONAL COMMENTS -------- ----- - ---------------- - --- ------------------------ ----------------------------------------------------- --------------------------- ' � � -- ` - --------- dP ! �11�1__ �� ' = �l ate' ---------- -- Final ! spection by: - ---- - -- ------ - ----------------�---------------------------- --------------------------------Date --�' --�- —�� - � JOAQUIN LOCAL HEALTH DISTRICT i E. H. 9 1-'68 Rev. 5M. ��j fI'; CJ 1� ( '✓ ��%�'r' (/ G % _/