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A 5 ,.FOR OFFICE USE: � APPLICATION FOR SANITATION PERMIT �71_ --r------------------- ---------------------------- Permit Na_ ---------------- (Complete in Triplicate) --------------------------------------------------------- This Permit Expires f Year From Date Issued Date Issued Application is hereby made to the San Joaquin Local Health District for a per 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/LOCATIONN--'------------.� �----� 1/' 00,D_WA_R�-------- ,-_CENSUS TRACT ------S-_s�.... Owner's Name ------------iA� ------[)I-L--DA��__!------- ---------------------------------------------------Phone ------------------------------ ---- Address / c7Q t------ [��"�'1 f AD City Contractor's Name ----0-kAfN-F-T-%-p--------------- -----------.License # ------------------------ Phone ---------------] Installation will serve: Residence partment House❑ Commercial []Trailer Court ',❑ c Motel ❑Other -------------------------------------------- ----- ------------------------------- -- -- - J _ 060 Number of living units:----- Number of bedrooms --- _____Garbage Grinder Lot Size _._/_ y -----------— Water Supply: Public System and name --------------------------------------------------------------------------•- _- ------------------------------Private�f Character of soil to a-depth of 3 feet: --Sand'El Silt❑- Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam . Hardpan ❑ Adobe ❑ Fill Material ------------ If yes, type ____________________________ sx� (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 seeps pit permitted if public sewer is available within 200 feet,) o .x t O r PACKAGE TREATMENT [ ] SEPTIC TANK .. Size_______________________________�- ,1-- Liquid bepth ______ '�._!'f...__ Capacity _/�Q0__ Type PA-E-0}_ -Material-092No. Compartments -----_-_-- __" � istance to nearest: Well ----------50 t.__ "�_____Foundation __IQ-__:7�_ Prop. Line 0 LEACHING LINE �No. of Lines ----7-------------- Length of each line------190-------------- Total Length ---------- - ----- /e D' Box (-___e Type Filter Material Mac&----Depth Fitter Material -__1 ------------------ y- --- V Distance to nearest: Well [? f--- Foundation /0__ _7Ilt—___ Property Line -�---------------- SEEPAGE PIT [ ] Depth -------------------- Diameter ---------------- Number ____________________________ Rock Filled Yes ❑ No i❑ Water Table Depth ------------------------------------------------Rock Size -------------------------------- Distance to nearest: Well ----------------------------------------Foundation _.-------------_--- Prop. Line --------------_.------ 0 REPAIR/ADDITION(Prev. Sanitation Permit# _________________________________________ Date ________________.___.-..__..--____) Septic Tank (Specify Requirements) F_------ _---- ---------------------------------------------------------------- _ -- ------ Disposal Field (Specify Requirements) -------------------------------------------------------------=------ -----r:----- ---------------------- 1 _____________________________________________________________________________'_____ _____ry _ -_____________.--------------------------------------------------------------- ---------------I-------- ------------------------------------- ="='---=-------•------------------------------- (Draw existing and required addition on reverse Side) r_ . . I hereby certify +that 1 have prepared this application and that the work will be done in accordance with San Joaquin County Ordinances, State Laws, and Rules arid Regulations of the San Joaquin Local Health District. Home owner or licen- sed agents signature certifies the following: 4- "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' omp ns tion laws of Californid: Signed _ �_!-- _ Owner -------------------------- ------------------------ ------------------------------------------------ Title ----------- ------------------------------------------------- (If other than owner) p FOR DEPARTMENT USE ONLY 7 APPLICATION ACCEPTED BY _.__—--- ------------------------------------------ -------------------. DATE - Z_7_1 -'-_71----- BUILDING PERMIT ISSUED -----------------------------------=---------------=------------------- -------DATE -------------------_:------------------•--- ADDITIONAL COMMENTS --------- --------- ---- -- --------- - - --------------- --- ---------------------------------------------------------------------------------------------- ------------------------------ - ------- ---------------------- - - --------- ----- -- ------------------------------------------------------------------------------ ---------------- - t - -- -- - - --- - _ - Final [nspec io -- - ------ ---------- -- --SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M