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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT / y ------------ -----------=---------- --------------- P Permit No. (Com le a in Triplicate] ---------=---------- Date Essued -----___'---. This Permit Expires 1 Year From 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: � c�C� ----------------------CENSUS TRACT --- ;----------- JOB ADDRESS/LOCATION--------------- ---11 _(-7/- -- ---r--G L - Owner's Name L -------•------------------------------------------- >-----------------.-Phone...U---F--�Pq7---------- Address --------------------- ----- : ._ ��' 1 Y 4 -----------------•- �35---��--�- -�=--�'�'rn'`�- --------•--� Cit -----�--------------- -�- ----------------------- Contractor's Name ------ ------ ---------------------License # ------------------------ Phone ---------------•----------- Installation will serve: Residence ❑ Apartment House❑ Commercial ❑Trailer Court ;❑ ' Motel [.Othere1(-A Aay-----------------•-- Q Number of living units------------- Number of bedrooms ------------Garbage Grinder ------------ Lot Size --------(q-------------------------------- Water Supply: Public System and name --------------------------------------------------------------------------------------------------------------Private ❑ . Character of.soil to a depth_of 3_feet:, Son:d_'❑_ vSilt.:❑� _Clays❑Peat❑ Sandy Loam ❑ Clay Loam F-1 Hardpan ❑ Adobe-2"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 [eT' SEPTIC TANK'{ ] size----------- --------- ------------------ Liquid Depth ---- -/zr--------__-_-. V --------- Capacity ------- ------ Type VFCe?��'t------ Materia! 60 ----- No. Compartments -------•--------_-•--- Distance to nearest: Well .........fes--------------------foundation ---1D--_---------- Prop. Line -1! -------u--- LEACHING LINE [ ] No. of Lines --------./------------- Length of each line--- 0__._.--------_ Total Length :_--__ ---------O .-----_-_ D' Box -----�'--- Type Filter Material $.p. ° -_---Depth-'Filter Material ---------- - - __-_-__--,.:_-___.;� s- -" 'Distance to nearest: Well ---14P-------------- Foundation -----1_-_---_--_--.- Property Line. SEEPAGE PIT [ ] Depth ---------_----- --- Diameter ---------------- Number ------ --------------------- Rock Filled Yes E] No 5 WaterTable Depth --------------------------------------- --------Rock Size ----------------- -------------- Distance to nearest: Well ----------------------------------------Foundation -------------------- Prop. Line ---------------.------ REPAIR/ADDITION(Prev. Sanitation Permit# ------------------------------------------- Date ---_------------------------------) SepticTank (Specify Requirements) ----------------------------------------------------------------------------------•------------------------ z. ------ :-----------------•- Disposal Field (Specify Requirements) ------------------- ---------------------------------------------------------------------------------------------------- ----------------------------------------------- ------------ - - - -------------- ----- ---------_-- ..--�---------------- - -- - ------ - ----- - --------------------------------------------------------------------------------------------------------------- (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 Districl. Home owner or licen- sed agents sign ture certifies the following: "I certify tha i the performa a of the work for which this permit is issued, I shall not employ any person in such manner as to bg subject to ork a6ls ompensation laws of California." Signed /t� - Owner ------------------------------ Title ---------------- ----- --------- ------------ ------------------- - - ------- (If othen owner) FOR DEPARTMENT SE OIL i. APPLICATION ACCEPTED BY -------------------- DATE -..4P-^-------�J-•------------------- ------------------------- =----- ------- - -- - - BUILDING PERMIT ISSUED - --- j - - - -- DATE -------- ---------------------------------- ADDITIONAL COMMENTS 11 k5 � A-1 - M---- ploy OA ,._- �' �?- 0, '; ---------------------------- ------- ------------------------ -------------------------- -- ----- --------------- -------- ---- - �a � ,- - - - ,---- x Final Inspection bY- ----------------------------------------------------------------------------------- -- - r --- :TCa - i. SAN JOAQUIN LOCAL HEALTH TRICT F E. H. 9 1-'68 Rev. 5M