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4 i FOR OFFICE USE: f - .-Arr'PLICATI.ON� FOR SANITATION PERMIT �- �{,�+�6 � u, Permit No. (Complete in Triplicate) i --------------------------------------------------------- ' ' R-: -^^ This Permit Expires 1 Year From Date issued -- Date Issued F ------------------------ 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: it , JJ : aJ� -- ----CENSUS TRACT -------------------------- JOB ADDRESS/LOCATION . -- ---`� _4-P1��r,.�__ti�l''r-- -P ----------- -- -- ---------- • ��'��-- Owner's Name �-�?'-�'--��a. �------------------------------------------------------------F-----------------=-Phone ------------- ---------------- Address --------------------- 44 ----------- ------------------ City - ------------------------=-----f----------------------------•-•--•-------- Contractor's Name -------@.1 ----------------- -' L` ` -------------------License # :_ Phone ----------- Installation will serve: Residence JX House-E] Commercial❑Trailer Court` ❑..+ Motel ❑Other "------------ ---------------------------- Number of living units:----- ------ Number,of bedrooms::.?-;-+__Garbage Grinder -- -I -_ Lot Size K-_----______________________ Water Supply. Public System and name------------- ----r----- ----------------------------------------------------------- -'---------------------Private ❑ Character of soil to a depth of 3 feet: --Sand'❑# 'Silt-E] Clay .❑ Peat❑ Sandy Loam•❑ Clay Loam,E] Hardpan ❑ >, Adobe Fill Material-_Al;�---- 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 [ ] SEPTIC TANK'[ ] f .Size------------- ------ ------ Liquid Depth -------------•.-.--------- (!►t. iS�1Y� Capacity --------=---------- Type - Material' No. Compartments til Distance to nearest: Well___' _____________________€._..Foundation ----_.__________'___ Prop. Line ____..._______________ i LEACHING LINE [ ] No. of Lines: ----- -------ILen6tli-of.-each line.--------------------------- Total: Length -----------.-_--___________ D 'Box""__- ----- Type Filter Material --------1~------Depth..Fi.lter Material -------------------------------------------- Distance to nearest.-Wel I ---------------------:-Foundation ------------------------ Property Line ____--_______________ '! SEEPAGE PIT [ ] Depth < _____�'-:_>_:_-___ 'Diameter,.______. #.x:_: Ntirrber ___________________________ Rock Filled Yes ❑ No i❑ Water.'Tcible'•Depth! �y '' `� ., ---Rock Size Distance to nearest: Well -------------------------------- f--Foundation -------------------- Prop. Line -------------_-------- r� REPAIR/ADDITION(Prev. Sanitation Permit e# ----------------------------------------- -- Date --:-------------------------------) Septic Tank (Specify Requirements) ---------------------------------------------------------------------------------------:--------- --------..-----------------------..._ I ter; i ire ��1 Disposal Field (Specify Requirements) 1=1�1U�g�----- ------------------------------ ------�--' CA--------------- fes` _.. �-�/ \Nk-Xkk----w2.1A): �,)' -----7 ---d3 )x+13__ _ ---�V(_��-----�e b � '# �� e. V' ----- '�31�--A-------- ------P ;�''��`I a 1°� 9---- ---------------------------------------------- (Draw existing and required addition on reverse side) I hereby certify that I have prepared this application and that tihe work will be done in accordance with San Joaquin I County Ordinances, State Laws, and 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 be:9j, rkma s mpensati.on laws of California." 1• Signed - ------------ ---- ---- - Owner ----- BY - Title -------- ------------------------------------------------------------- (If other than owner) FOR PRARTMENT USE ONLY APPLICATION ACCEPTED BY ------- - - `- ---------------------------------------. DATE ----------- -- - - ----- ------ -- BUILDING PERMIT-ISSUED-- ---:7- _= --T =�'L--- -----__-_-=-:._ : _-_-_DATE-_-----`--------------------------------- ADDITIONALCOMMENTS ------------------- -------------------------------- ------ -------------------------------------------------------------------------------------------------- ------------------------- --------------------------------- ------------- ------------------------------ M. - '`'~== = = '- ----------------------------- ------- Final Inspection by: ----------------------------------- ---Date - ----------� -------- SAN JOA IN LOCAL HEALTH DISTRICT I E. H. 9 1-'68 Rev. 5M.