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FOR OFFECE USE: ' APPLICATION FOR SANITATION PERMIT ------------------------------------------------------ - �� (Complete in Triplicate) Permit No. 4 4_.�--_-._. ` Date Issued ____________________-___�I____ 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'.lis made in compliance with County Ordinance No.. 54._9��and existing Rules and Regulations: JOB ADDRESS/LOCATIO .Q. ------------- •- -.CENSUS TRACT --•-----------.. _ ...... Owner's Name .------ .--?_4ze'vae, - Phone ---------• ----------- ------- ------- --------------- v2- ------C�--'-- Y Address ------------- ---0 - ----- - - ----- --•-•- -... Cit - - -- - - --- ----------------------------------------._...------------ Contractor's Name ---- ----- •• 3s� ------- �� _.License# t��.�� "- Phone Installation will serve: Residence Apartment Nouse^❑ Commercial.:❑Trailei Court ,❑ Motel ❑Other -------------------------------------------- Number of living units:..___,_____ Number of bedrooms ---I-------Garbage Grinder ------------ Lot Size ----0-e-k4rd-- ------------ ....... Water Supply: Public SystemIand name --------------------------------------------------------------------------------- -------•--------•------------Private ©� Character of soil to a depth I�f 3 feet: Sand❑ Silt❑ Clay ❑ Peat ❑ Sandy,Loam Erl� Clay Loam;❑ 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.) N NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ ] N SEPTIC TANK'[ Size/cZ�si'.._ ��I' _�------------ Liquid Depth .-_-y_ �.-___-- I Capacity _f Pn. Type &0041 ------------ Material �° ''� '-_ No. Compartments -4_4................. .r DIs,tance to nearest: Well ------.�0---__ __________________Foundation ../�__.._..____._ Prop. Line ___�_---:_-..___ �la LEACHING LINE [ef No? of Lines ---------IE g ` g I ------------- xLen th of each line---.---�-9.Q_.._". - .-- Total Len th -_�-�©----------_--_-- .z. 'D'I�Box -C ,k,,,$__ Type Filter Material _.. .TL_.-_---_Depth Filter Material --_-----/__9......... .............--____ Distance toi nearest: Well -------5-A.......... Foundation ------1-Q--.`---------- Property Line, --_ -------------------- SEEPAGE PIT _.f____----- -._SEEPAGE-PIT [ ) Depth ------------- {_... Diameter -------------- Number ---------------------------- Rock Filled Yes ❑ No i❑ � f W iter Table Depth-----------------------------------------------------Rock Size ----------------------------- Distance to nearest: Well -.�--------------------------I---_--- -Foundation ---------------.---- Prop. Line ----------------•__-•- REPAIRfADDITION(Prev. Sanitation Permit# -------------- ----------------------------- Date ----------------------.-----------1 Septic Tank (Specify'Requhi-rements)- ° `s Disposal Field (Specify Requirements) -------------------------------------------------------------------------------------------------------------.-- --------=------------- --------------------------------------------I� --------------------------------------------------------------- ------------------------------- ------------------- ----- ------------- i ------------------------�N---- -- -------------------------------------------------------------- ------------------------------------------ ------------------------ ------------------ - - - (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 District.,Home owner or licen- sed agents signature certifies the following: i "1 certify that in the perforrhance 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 California." Signed I (�\J k ,w ----------------- Owner V . • - 7-- y'�4C�-r --------------------------------------------------- (If --.-----_ £ BY Title . (If other than- caner) FOR DEPARTMENT USE ONLY ,i. APPLICATION ACCEPTED BY _ t c. _-- -------------------------------------------------------------------------- DATE -..f ."ate _ Q---------- BUILDING PERMIT ISSUED !,i'--------------- - -------DATE -------------•----------------------- ADDITIONALCOMMENTS -ll•------------------------------------------------------------------------------------------------------------------ ---------------------------------------- "ii` '-------------------------------------------[---------- ----- ------------------------------ --------------------------------------------------------------------------------- i ------------------------- --------- Final Inspection by: ------ --- A ---------- -------------------------------------------------------- �d7`---------� ---- -------.Date -- --------- - SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M. �,