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FOR OFFICE USE:- ------------ -- APPLICATION FOR SANITATION_'PERMIT - ' Permit No: (C omplete in Triplicate) f r. I ____ 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 Rales and Regulations: � JOB ADDRESS/LOCATION .--`- -- -�------------ � -- ' � - - ---- �---- � L� --'C -- ------------ ------ ------- --CENSUS TRACT _-- -6---- Owner's Name --- tL-� - - ------------------ - P—TT-------- -------------------Phone Address ).5-3-1 r ----- 0---f�-�--t--------------------------------------- -- -- -- City s Contr } y actor's Name .__;-- S--IFL --------------- k -----`Phone ----`-- --- ` Installation will serve: -41 Residence Apartment HouseCommerc al.DT ailer�C I F Dort i❑ r E` I Motel ❑ Other i Number of living units:--A------- Number of bedrooms _ ___-.Garbage Grinder-.Lot Size Water Supply: Public Sysi6 and name ----C—&I__--_--_�- � Private ❑ --------------------------------------------------------- Character of soil to a depth of.3 feet: San '❑dSilt F-1Clay [I Peat❑ Sandy Loam E] Clay Loam Hardpan D Adobe Fill Material ------------ If yes, type ---------------------------- (Piot,plan, showing'size}of,lot, location of system incelation to wells, buildings, etc. must be placed on reverse side.) NEW INSTALLATION: (No septicitank or seepage pit permitted if public setwer is available within 200 feet,) f v PACKAGE TREATMENT [ ] SEPTIC TANK9 X � 2r__._ Liquid Depth __ __2-------------- Capacity_ Qi?( -Q- Type Material-_ _ %wb, No. Compartments ---__--_- \ Distance to nearest: Welly _ . Foundation )Or Prop. Line Qt LEACHING LINE No, of Lines t ngth of each line---j-��0-------------- Total Length ------------- 'D' - Box, ._ Type Filter Material +t . r, � DM ----- �i h Filter IJMaterial______________ Property----�-��------ -Line----- -�---------------------- SEEPAGE PIT Distance to nearest: Well Foundation _00_ f�C` :pth - - ----- - - Diam'te� _(1L------ Number &1�---------------- Rock Filled Yes; No - Water Table Depth = Rock Size 11.0 L Distance to nearest: Well _ -----------------------Foundation ------------- Prop. Line -- ---____ REPAIRJADDITION(Prev. Sanitation Permit# -------------------------------------------- Date ---------------------------------- Septic ___ ______Septic Tank (Specify Requirements) --------------------------------------------------------- .Disposal Field (Specify Requirements) ___________________________ r. I --------------------------------------------------------------------------------------------------------------------------- -------------------------------------- ---------------------------------------------------- (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 fallowing: "I certify that in the performance of the work for which this permit is issued, I shall not employ any person in such manner g rkm 's m ensq ' n laws of California," p Si nedql._ as a become je t to Wo -� Owner - ------------------------- BY --------------------------------- -------------- '--- ---------------- ----------------------------------- Title ----- -- -------- (I other.than owner) . FO DEPARTMENT USE ONLY APPLICATION ACCEPTED BY --- -----. DATE�3-4 � �•------------------- -- - -- -------------------------------- DiNG PERMIT ISSUED i---------- DATE ADDITIONAL COMMENTS ------- f- --''=4 - ----------------------------------- ------------------------------------------------------ ______________________________________________ ________________ _______ ----- ------ -------- -- ---- ---- -.-i------ ----- ----- - - - - -- ----------------------------- ----------------- ------- ------ ---- ' ----------------------------- ---------------- - - -Zc-------- ----------- -- ---- Final Inspection by; ---- ---- ------- - -- ----- -- ------ - ---- f r - Date --------------- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M