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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT----------------------------------- --- ----------------- Permit No. `1,C9© (Complete in Triplicate) ------- � r --�-"-------_---. -- ----------------------------------------------------- This Permit Expires 1 Year From Date Issued 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 is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: .EL, Dt7AA-:00 Sr• . �/ JOB ADDRESS/LOCATION - ! .. % 1P ENSUS TRACT --------------.___________ Owner's Name -/IM �L j� _iPCI [� ` Phone FS-�l -- 1~_!f_7_1 Address E �a`� Q -0� t- ---- --------- City _R05 —I LLQ Contractor's Name ------- A S,-H-- L-A -G---------------------------License # Phone Installation will serve: Residence ❑ Apartment House❑ Commercial ❑Trailer Court '•❑ Motel ❑Other Number of living units;------------ Number of bedrooms -----------.Garbage Grinder ------------ Lot Size -�_____________________________________ Water Supply: Public System.and name ---- Private [ Character of soil to a depth of 3 feet: Sand'❑ Silt;[-] Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam f$i Hardpan ❑ Adobe-❑ Fill Material ------------ 1f yes,type ------------------------- (Plot ______________________(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.[ Size___-`{ __ _ __ _--------------- Liquid Depth _�z__..._--_-______ Capacityf �7 _-_____ Types _ Material- - No. Compartmentsc--___-_-____-_ Distance to nearest: Weil _r _ =7 ___________________Foundation _40---- --------- Prop. Line ____/�_f______� N LEACHING LINE [ ] No. of Lines IQ_7�s, 5 ~Length of each line____________________________ Total LengthS_� 1_� J ff X 'D' Box --- CiS Type Filter Material �1Zx depth Filter Material _15-- Distance to nearest: Well 1;4��-_---____ Foundation f_V________________ Property Line .............. SEEPAGE PIT [ ] Depth ___________________ Diameter ---------------- Number ---------------_E------- Rock Filled Yes E] No 0Water Table Depth -----------------------------------•------ Rock Size --.--------------------- Distance to nearest: Well ________________________________________Foundation ----------------._-. Prop. Line ________-_______-._... REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date ______________-_-_______________1 V' SepticTank (Specify Requirements) ---------------------------------------------------------------------------------------------------------------•-•----------------------•---• N Disposal Field (Specify Requirements) ------------ -------------------------------------------------------------- --------------- ------------------------ -- - - ---------------------------- - -- ------------------------------------------------------------------------------------------------------- (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 certify that in the performance o the work for which this permit is issued, I shall not employ any person in such manner as to become ject to Wodcman .Com tion laws of California." j , Signed --- ---- -------Q-1U--- - ----- Owner r� By ------------------- jjJ�4 ---- Title ------ ------------ --------------------------------- (If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY __.__-___` __r__u ___.__.________ DATE _._//--_3,;::1__.-_-:.7_Z__.__--___- - -- ----------------------------------------------=-------- BUILDING PERMIT ISSUED --------------------- -------------------------------------------------------- --------•--------------DATE -------------------------------------------- ADDITIONAL ------------ -----ADDITIONAL. COMMENTS ------------------------------------------------------------------- ----------------------------------- ---------------------------------------- ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- - ----------- ---- -- ---------------------------------- ------------------------------------------- ---------------------------------------------------------------------------------------•- -- ----------------------------------------------- - --- - - ------------ - - - - ------ ----- Final Inspection by. C�'�`' ------------------------ -- -- ------ Date -----~ ------------------------------ SAN -------------- SAN JOAQUIN LOCAL HEALTH DISTRICT Gj3 E. H. 9 1-'68 Rev. 5M ��