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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ----------------------------------- ----------- , (Complete in Triplicate) Permit No. - ---------------------------------------------------- --- Date issued 07/`/-&6111 ---------------------------------.---------------- his Permit Expires ] Year From Date Issued 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 .---30- 1_._____�----- D UAR- ��'`-'---------------------------------CENSUS TRACT ------4�_--------_---_-- Owner's Name ---------- }� n Q _------ -------- -•-------------------Phone ------------------------------------ Address ------3Q_Q_,'-l..- ------------ ----------------- ------------------ CityeAKPAL� V'------------------------------------------------- Contractor's Name } _-C A1�--"�� - ---------.License # Yl--- Phone ------------------------------ z Installation will serve: Residence ❑Apartment House[] Commercial ❑Trailer Court ',❑ Motel ❑Other ------------------------------------------- Number of living units:---(."----- Number of bedrooms _;�=--Garbage Grinder ------------ Lot Size A --`-----•---- Water Supply: Public System and name ------------- ------------------•---------------------------------------------------- -----------------------Private Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ sem.-. Hardpan EJ 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.) NEW INSTALLATION: (No septic-tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREAfTMENT [ ] ' SEPTIC TANK,} ] Size-------------------------�-----_-------------- Liquid Depth ----------------------.--- \ Capacity ------------- ------ Type --------------------.Materia l No. Compartments ------ --------------- i: Distance to nearest: -Well ------------------------------------FoundationLine ---------------------- LEACHING ---_---------------_-LEACHWG LINE No. of Lines '-/------------------------,_ .Le,.ng_th of each lined._-_-. ".---------[ 't r --jot a,f Length 'D� Box _--__.----- Type Filter Material ------_---,:F-----Depth Falter Material ---------------- ------------- -------------- Distance to,nearest: Well ----.-------`---_------- Foundation ------ ---------------- Property Line ----_--_-_-.-.----_--_-- SEEPAGE PIT [.J Depth -".- ".-___-_ Diameter -------------- /"Number .-_----- � Rock Filled IYes ❑ No i❑ r rs t i s I WaterTable Depth ------------------------------------------------Rock Size -------------------------------- ' f Distance to`nearest: Well --- ---------------'---------------------Foundation ---------------."--- Prop. Line ---------------------- I l REPAIR/ADDIbb144JPrev. Sanitation Permit#------------------------r____.__"-.-_----"--- Date ---------------------------------- Septic Tank.(Specify Requirements} ---n,- '°------ -----------------------------------------•---------- - ----- Disposal Field (Specify Requirements) `------ �Jry..----------- - ---=-------------------�------------------------------------------------�i---------------- - �' V00 CSC, � T # i - 14: ------------------------------------------------------ -------------------- (praw'existing and required addition on reverse side) I hereby certify that I have prepared N'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: r' "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 California." Signed y - ---�----- ---- - --- Owner By _ - cQ.-- Citle f" ---- --------------------------- (If other than owner) \ FOR. DEPARTMENT USE ONLY APPLICATION ACCEPTED BY.------` �i_ '_e©- ------ ----------------------------- -1-- DATE ------- -'-13�---6 " BUILDING PERMITISSUED _ '- - - --- -- - -DATE- ___ = _= ADDITIONAL COMMENTS ------------------------ ` ' -` -= -' ° `= -- -- -- --- - -- -- - -- ---- -------- ------ - --------------------------------- -- -----------------------------------------------_----------------------- ---------- ------------ -------- -- - -XI- Final Inspect' b a -------------------------------- -------- ----------Date ----- SAN -- �.p} SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M 3.