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FOR OFFICE USE: it APPLICATION. FOR„ SANITATION PERMIT �g :,—Permit No.-_c---- - ............ i {Complete in Triplicate} < ------------- -------------- = _. Date Issued This Permit Expires 1 Year From bate Issued + - f Application is hereby ma�cle to the San Joaquin Local Health District for a permit to construct and install the work herein described. This application .is mode in compliance with County Ordinance No. 549' and existing Rules and Regulations: t JOB ADDRESS/LOCATIONZ1� _1 ��` _�__L� _ / LP CENSUS TRACT ------ ------------ p. Owners Name ; S7e --------- -•----------------- ---------------=- ----------- -- - ---Phone? Address '�j'C� /= 1 _ .� � ---------------r-----------------------------. City f� _ Tom_ __ y .} Contractor's Name _ II'.ply__«�.e � ----�/t'1 ------------ License { _V__ Phone`------------------ _/ �f will serve: -Residence 0 Apartment House Commercial❑Trailer Court i,[- Installation Motel [] Other -------------------- -------F--------------- Number of living units:.__-.- Number of bedrooms _�/__-__-Garbage Grinder Lot Size _► ------------• Water Supply: Public System and name ---------I_:-------------------------------------=-------------------------------------------------------------Private 2�� Character of soil to a depth of 3 feet. Sand'[] , Silt❑ Clay E:1Peat E] Sandy Loam -Clay Loam E] 4� Hardpan 0 Adobe❑ Fill Material __1V0__ If yes,type -------------------- ` (Plot plan, showing size�-of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) 2 NEW INSTALLATION: (No septic tank or seepage pit permitted if p blit se er i ay�a9 able within 200 feet,] tr � PACKAGE TREATMENT [ ] SEPTIC TANK f ` Size_ __ ___ -f-�- Liquid Depth f_----------------- �o S. Capacityf�- Type 750 =-- Materia ,�E No. Compartments __ ---_`__r__.:.-. ry j Distance to nearest: Well -�0---------------------,.�---Foundation -------.------- Prop. Line _4Q--------------- I �, 12 �d _g �� 60 f ------- LEACHING LINE [� No. of Lines --------- -- Le gth a eat li Total Lengl _ -- ---- 'D' Box l is Type Filter Material A &-_____Depth Filter Material �f------------------------------------ 011 J Distance to nearest: Well [_'e_-_____---_ Foundation __1471---------------- Property Line_ -� __� A l ' t _-.____ Rock Filled Yes : _- No G SEEPAGE PIT [ ] Depth ------------------ Diameter ---------------- Number --------------_- -- ❑. C3 Water Table Depth ------��------------- - ----------•--- Rock Size ---------------------------- t ( Distance to nearest: Well ---- - ' Date ----- Pro41 p. Lin ---'_--. -- REPAIR/ADDITION(Prev.'Sanitat"on Permit# ----------------------- -=--- = - + .. s I - Septic Tank (Specify Requirements) -------.._- -_---_ Y ` r.. Disposal Field (Specify Requirementsy ----, ---� _'L� .- - ----- �i IV f/V-------'-- ---OV�~ { --------------------------------------I _ -------------------------------------- I [---------- --------------- ------- -----------------------------------------------------------=---------------------------- ---------------------- _ I ” (Draw existing and required addition on reve#se side) I hereby certify that I have prepared this application-and that the work'will-be done in accordance with_,S6n Joaquin County Ordinances, State Ldws, and Rules and Regulations of the.San Joaquin Local Health District: Home owner or licen- f 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 subject to Workman's Compensation laws of California." Si ne' ii --------- ---- ---------------------------------------------- Owner g - B fl- = - fide Y k i other t bn'owner i j u OR DEPARTMENT USENLY APPLICATION ACCEPTED BY ._._',2-_" --� � ! .-[/t 6 Z -----------• DATE -`� --- -`=-Al ------------ 4 BUILDING PERMIT ISSUED _..__________________________ ----------------------------- /---------------------------DATE -------------------------------------------- ADDITIONAL COMMENTS ----------- ----- ----------` ------------------------------------------------------------------------------------------------------------------------------------------------- ____ ________________ _ _ _______ __ _ _______ ____.-_---- - _.______----------___._____-- ___________________________ ___--- $ -------------- r Final Ins' ectio- Date 4 SAN .JOAQUIN LOCAL HEALTH DISTRICT t E. H. 9 1-'68 Rev. 5M �`