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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT 71- _/0, 1 �� --------- Permit No: (Complete in Triplicate) •3"-7 r'}"9�_--_ This Permit Expires,)Year From Date issued Date Issued __7l_.. r 4 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 existin Rul njR ulations: , pp � p a �� / JOB ADDRESS/LOCATION . . :-'-_s_ NSUS E / _..----•-_. Owner's Name - -------------------------------------------- ---------+-------Phone ----------------y- ------ Address --------3 a-f � "` 1 --------- -- -------------------•--- City J °^� I / / Contractor's Name . �-7=Q L -- ----------=------ -- / ' ---- Phone License # �.. .. Installation will serve: Residence,0_Xp`a_rtment House'❑ Commercial ❑Trailer Court 0 " + ' Motel ❑ Other -------------------------------------------- Number ----- ----- -- ----Number of living units:'___`_/__._ Number of bedrooms _____ ____Garbage Grinder, Gam.__ Lot Size .__ °- -----------•--.-____ Water Supply: Public System and name _ ____Private Character of soil to a depth of 3 feet: Sand❑ Silt❑ Gay _ Peat❑ Sandy Loam ❑ Clay Loam,E] 1 Hardpan E] Adobe-Up-'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 TANK [b]' ze_____�`,�m5` j------ ------------ Liquid Depth i ~ Capacity/s-��_____,r Type ____ ,i't MaterialfJi _ No. Compartments ___________ __ Distance to nearest: Well ____________________________________Foundationda__________ Prop. Line _5___ j ---------- Length :______. LEACHING LINE^ - 1_No. of Lines -_ Length-of-each line .� ._ -- Total Len th [ - !�. g -== 'D' Box .._L _ Type Filter Material A - ` epTh Filter Material ------/-,F-f.f:_______________________i Distance o nearest: Well _____- ---___________ Foundation -_,/_____..__________ Property Line `!__�________________ SEEPAGE PIT [ Depth .l r Diam er _-- ./ .-----_---------- Rock Filled Yes � 1�o i-� -- ----- NumberWater Table Depth ------------��- --------------- Rock SizeX -----------Distance to nearest: Well ____._=-_______ _________Foundation _ _ _________ Prop. Line _.'5_____......... REPAIR/ADDITION{Prev. Sanitation Permit F# _______•._________________________________ Date ----------------------------------) i SepticTank (Specify Requirements) ----------------------------------------------------------------------------------------------:----------------• •---------•- Disposal Field (Specify Requirements) ------------------------------ -------------------------------------------------------------------------------------•--------------- ---------------------------------------------------------------------------------------------------- ---------------- --- --- --- --------- ----------------- - ------------------------------------------------- ---------------------------------------------------- -------------------------------------- z (Draw existing and required addition on reverse side) I hereby certify that 1 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 certify that in the performance of the work for winch this permit is issued, 1 shall not employ any person in such manner as to become subject to Workman's Compensation laws of California." Signed ------------------------------------------------------------------------------------------------ Owner , A_ BY - - - - ----------- LL/irl & Title . � / -_ - - - ---- - - - - --- (lf other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY _ - . DATE --- `_ ? BUILDING PERMIT ISSUED ------- I- ---------- �: DATE ---- ----- ---------------------------- ADDITIONAL COMMENTS -:- ---- --------- - --------------- ..�a � �. ---------------------------------------7� _ -Fe-------------------------------------------------------- - ---- -- ----- --------------- Final Inspection bY= - ----- -------------------------------------------------------------------- --------------------------.Date �� off 7� I SAN �JbAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M 1