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FOR OFFICE USE: p APPLICATION FOR SANITATION PERMIT :� L 1 (Complete in Tripfica}e1 Permit No.� - . ---- ----------------------------------- This Permit Expires 1 Year From Date Issued Date Issued 645-70 4 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 .4 -__ _Q---- .�' ,,�/ _ � ----- f- --1/t'-�.L-�._C�-. ----------------------------------- ---------CENSUS TRACT _-.- ---------------- Owner's Name -NY-----------51JA- —:5 ---------•--------------- -------Phone �`D h�C - Address ------- Rot--------------------------------- ' Cit -- _ Contractor4 Name �1�'C',$_----••J�.e .�/7 ------�-.�W,_ ----- /- License # �� j� Phone = fr.. Installation will serve: ResidencejD J Apartment House❑ Commercial ❑Trailer Court !❑ Motel ❑Other ---------------------- Number of livingunits:_._ ; " c / Number of bedrooms -_�-_-_--Garbage GrinderLot Sizeo - Water Supply: Public System and name ---------------------- --- --- ----------- --------- ------------------ -�- - _ Private E]- - -------------- Character of soil to a depth of 3 feet: Sand'Q Silt❑ Clay .❑ Peat❑ Sandy Loam -❑ Clay Loam,0 Hardpan ❑ Adobe* Fill Material ------------ 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 septic tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT ) ],i SEPTIC TANK�j Size----5"k �/3;/, / Liquiduid Depth _ Capacity (V,�} /-&-10-log/ Type� �rMateria�-�Ql�. vo. Compartments - t r --- ------•---'---- Distance to nearest: Well ---- 0---------- -----------Foundation -.Cp_r---___--._ Prop. Line - _�.____-_•____ LEACHING LINE ' No. of Lines - 'off o' �- ----- Length of each line------y4------- ----- Total Length _-11Q.,----------------- 'D' Box R-0.--- Type Filter Material -__Depth Filter Material ---- Distance - -Distance to nearest: Well f' ---------------- Foundation ---1_©-------------- Property Line � 3 SEEPAGE PIT Depth _.------ --_ Diameter ---� ! 3 ---- -- Number --.-. ,--/------------1-- Rock Filled Yes V No .0 Water Table Depth ---0167--------------------------------- Rock Size r Distance to nearest: Well _.--- __-0_(9----------------- Foundation - -- /0--- ------- Prop. Line -.1--------=........ ' REPAIR./ADDITION(Prev. Sanitation Permit# -------------------------------------------- bate ---------- -----•------- - ) - - -------- Septic Tank (Specify Requirements) -.___----_--_--- -. - ---------------------------- -- -- - - ------------------------------------ Disposal Field (Specify Requirements) ------------- -------------- ----------- ---T' (0)-- fi ��c ------------ '�! .- - 5 /?-'fest/ f-------- C -rt•----- r �� - ---------------- - ---- � s (Dra existing and ri quired addition o e side) I hereby certify that 1 have prepared this application and that thew ' h Son Jaqu County Ordinances, State laws, and Rules and Regulations of the San Joaquin Local be oHealth Distrne in ict.Homeance towner oro I cen 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 suVto man' ompensation laws of California." Signed ------------- A - --- -------- ----------------------------------- weer BY -------------------- other than owner)---------------- Title -------------------- -------- ------------------ R DEPARTMENT USE ONLY APPLICATfON ACCEPTED BY--- . PERMIT ISSUED - ---- . DATE ---- ----`S------- BUILDING O -- A DIT N L COMMENT --- --- - ---- --------------DATE -------------------------- - --- ---- -------------------- --------------------- -- ---------- ---------- ----------- ----- ----------- --------------------------------------------- ina Inspection by: --------- ---------------------------------------------------------------------------------------------- ------------------------------=------- - - --------- - -------Date ---��=�------ �- A JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'b8 Rev. 5M, fi