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FOR OFFICE USE: .� APPLICATION- FOR SANITATION PERMIT ry ----------- ;? 1!' Permit No: ---7----__`.�-06 i (Complete in Triplicate) . 7S --------------------------------- This Permit Expires 1 Year From Date Issued bate Issued _ _____� ___. I 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 .__..�o��P0_C,i}-p?'---,Ct l?I<13iL-- _ --- ----------------------------CENSUS TRACT ------ JOB Name ------------------ 11��{= 1��e"'� ------------- ------I----------- ---------------Phone ------------------------------------ Address ---------------- -- w, ,. Com` --------------------�----�----�=�----- ---------------- Address -----------------------------------------`'�1 `.--------- I --------------. City ____t_Rgcv-------------------------- --------------------•------ Contractor's Name ---------------------- o5e----------------------------- I License # PAW_; ----- Phone t35 _ . ......-- I Installation will serve: Residence El"partment House❑ Commercial ❑Trailer Court i❑ Motel..F1 Other --------I1----------------------------------- Number of living units:________I.. Number,''4 bedrooms _________Garbage Grinder __ ____ Lot Size ____________________________________-•____ Water Supply: Public System and name sT ----------------------------------------------------•------ ------Private ❑ Character of soil to a depth of 3 feet: Sand'❑ Silt❑ i Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam;❑ - -.Hardpan ❑ Adobe-E]"' 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 [ ] SEPTIC TA K f ] Size_________________________________________ _____ Liquid Depth -------------------------- Capacity - -- Type -------------------- Material---------------- ---- No. Compartments ------ --------------- Distance to nearest: Wel __ _-____-I-------------------------Foun tion ---------------------- Prop. Line __,_____________._-- LEACHING LINE { ] No. of Lines _______________________ Leng. f each line ------------------------ Total Length ------------------------------ 'D' __________-______-_:______'D' Box ------------ Type Filter Material ___________ ______Depth Filter Material ----------------------------------- :j .� Distance to nearest: Well ------------- ---------- ound • n ------------------------ Property Line- ----_----------.--._-_-- SEEPAGE PIT [ ] Depth ______________ _____ Diameter ___-.___ _______ Number ------ ------------------- Rock Filled Yes ❑ Na i❑ � I Water Table Depth _______Rock Size ___ _ -------------------------- Distance to nearest: Well _____ _______i ________________________Foundation _______ ________ Prop. Line ----------............ REPAIR/ADDITION(Prev. Sanitation Permit# _____________________ _____________________ Date __________________________________I 1 SepticTank (Specify Requirements) -------------------- ------------i--®---- ------------------------------------------------------------------------------------------------ Disposal Field (Specify Requirements) ---- ---- 11t1 ------ ---- � ----- E + ------�YL -----------------------------------------------------� a -------------- - ---------- --- (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 Regulation's 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 become subject to Workman's Compensation laws of Califdrnia." Signed '`: '' 2 L° .--------------------------- '.- � re Owner � . By -------- ------ ------------------------------------------------------- ----------- (If other than owner) ;' _::', FOR DEPARTMENTa, 15E' ONLY APPLICATION ACCEPTED BY -------- ------ - DATE 3 ! �'-�� -- BUILDING PERMIT ISSUED ---------------- -----------------' ------------------------------------------------------DATE - ------ -------------------=------------ ADDITIONAL COMMENTS I -- --------.---- ----- -- ----------------------------- II ". r £Kr.. - --------------------------------------------- ----- ---------------------------------------------------------- ----------------------------- -------- -----------=---------- -------- ---- -- --- ---------- 1 --- -- - ------------------------------ --- ----- -- ------- - Final Inspection b �� _Date -_- '__ __________________ SAN JOAQUIN LOCAL HEALTH'.DISTRICT '* r E. H. 9 1-'68'Rev. 5M h_