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FOR OFFICE USE: 4 1 .APPLICATION FOR SANITATION PERMIT ------------------------------------------------ ------- .Permito. ��`` (Complete in Triplicate) } ----------'------------------- --------------------------- f ------------------------------------------------------- - This Permit Expires 1 Year From Date Issued Date IssuedIN/ AV i Application is hereby made to the San Joaquin._Localea t &strict for a permit to construct and I install the work herein described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: ,�,.�; .�• �f. p � ;�,.x, JOB ADDRESSAOCATION .� � -- -`- - --- r_ trv► R_._f�,--_. OEN US. TRACT -------------------7T Owner's Name �� E - 11 .eQ J_� 4 �t [ - Phone _ �" Jd l�-------- Address - 1dz ---- ----------------------•--. City -- ------------------------ ----•-- ------- - - - i � 1 & Contractor's Name.-".r7'---,. i / ' rl-$------------------------License # _09V_ .-7Z---------- P one -.-- Installation will`si3rve ''`"":6 Residence F] Apartment House❑ Commercial :❑Trailer Court ;❑ yy ` i "•� '' Motel E] Other,h &- ------ ,�aosrr Number of living units'.:._.___.___Number of_bedrooms-------------Garbage Grinder ------------ Lot Size ----,,._---_-_----.---_-_--_--__-----_-_-_ Water Supply: Public�ystem and name ----------------------- ----------- ------- --------------------------------------------------- # �--------Private Character of soil to a depth of:3 feet:, Sarid❑ Silt:❑ Clay ❑ Peat Sandy Loam ❑ Clay Loam ❑ 1 ! ' Hardpan ❑ Ad be ❑ Fill Materia :-------- If yes, type .��`.--I------------------- � { %(Plot plan, showing size of\l'ot, 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'[ I Size------------------------------ ------------ Liquid Depth -----------------_-:--- 1 Capacity -------------- Type ------------------ Material---------------------- No. Compartments ---------------------- Distance to nearest: Well ._16- -- -------------- ___Foundation ___________-_ -______ Prop. Line -------------------- LEACHING LINE [ j No, of Lines ---------- _-------- (Length of each line_---__-_.________._..._-_ Total Length ____________________________ 'D' Box .__.______,Type Filter Material --_----__ Depth th Filter Material ----'-------------------------_- Distance to nearest: Weil ------------------------ Foundation ------------------------ Property, Line- ------_---_-_--_-_-•---- SEEPAGE-PIT) [ ] Depth --------_•-----------'Diameter ---------------- Number ------------ -- Rock Riled Yes ❑ No 0 ' 3 ""' Water Table�D pth = '`-----------------------------------------stock Size --------------- ------ Distance to nearest: Well'----------------------------------------Foundation -------------------- Prop. Line ----------- ...... REPAIR/ADDITION(Prev. Sanitation Permit#w:--'--------------------------------------- Date --------------------------...._.-- p Y q --- ---------------------------------------------- ------- Res osa! Field (Specif- Re virem� Septic Tan (Specify Requirements ------------ ----------------------- AP—_W------/C-�� ------------ �,eJRJcq , / s� � r%f�. = 4 ---------------------------------------------------•-- ----------------------------------- {Draw existing and required addition on reverse side) "aj I hereby certify that I have prepared •this application and that the 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 parson in such manner as to become subject to Workman's Compensation laws of California." "t :By igne --------------- --------------------------------------------------- Owner - -------------------------------------------------- Title _- --------------------------- #--- ---------------------- (If other than owner) + FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY . ---------------------------------------------------------- DATE -------------- -y.Z - 7e--------------- BUILDING PERMIT ISSUED ------------------------------------------------------------------------------------------ -------DATE )--------------------=------------- ADDITIONALCOMMENTS ---------------------------------------------------------------------•--------- --------------------------------------t 1---------------------------------- -------------------------------------------- -------------- - -- t---------------- -------------- ------------------------------------------------------------- -------------------E )------------------- -------------------------------------------------------------------------- - --------------------------------- --- ---- ! { -------- Final Inspection by: ------ `'�.e✓-- --- ---- - ----------------------- ------------ --------- ------ --------------Date --- - --7Z- SAN JOAQUIN LOCAL HEALTH DISTRICT { E. H. 9 1-'68 Rev. 5M