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{- - FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT R i I (Complete in Triplicate) Permit No: �-- - --4. -------------------- ------------------- ---------- I Date Issued - ---------------------------------------------__ This Permit Expires I 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: --- 16B ADDRESS/LOCATION -------- 0----------- -.-_- .._.__.CENSUS TRACT _ p� j ( Owner's Name ---- --------------- ------ --- - G� q _'rQ,t2 Phone._-- Address ----------- �� -T`-�' I��I.... City -- -- - --=- - Contractor's Name _ __________________ Li ______ cense# - 1�----- Phone _ - �¢J. Installation will serve: Residence ❑ Apartment House 0 Commercial :❑Trailer Court ,❑ ''��'�� , �.�.�. ) Motel ❑Other ------ N-umber _.__rNumber of living units:------------ Number of bedrooms ___- __Garbage Grinder'"-':____ Lot.Size _______________ _ WatereSupply: Publ-icSystem-and name----------------------------- _ y--------------------------------------------------------Private Character of soil to a depth of 3.feet: Sand X Silt 0 Cla y':❑ Peat❑ Sandy Loam Clay Loam ❑ `( ;Hardpan❑ Adobe❑ Fill Material ------------ If , type a ---------------------------- Y (Plot plan hawing size,of foto locatiof system in ielation towells, buildings, etc:rt'iust be placed on reverse side.) NEW INSTALLATION.; ON a,septic tank or seepage pit permitted if public sewer is available within 200 feet,) I PACKAGE TREATMENT ;[ ] SEPTIC TANKYA- ize==_��a(-_ -----------------E--- Liquid Depth __-- �._--_--_- hll , - - _#�_ fo �;I capaq L ,fYP� 15---------�--- Material'= 4 .- No. Compartments ________._._.- Distance to nearest: Well ___- Q_,-------- ------------ .......!-------------- Prop. Line __,�_ 7`-- f_EACHING LINE No. of Lines I________________!-__ ---- Length of each line _.-.__h______�___'_ Total Length -------tom--------- . S [ 'D' Box -___.__o-_. Type'FAilteF Mb e�ial"__ =__.Depth Filter Materia! -----2&__#F"__._ ----------------•-- Distance to nearest: Well ____- �__----___-_- Foundation ------A-) #-__- Property Line S�f" SEEPAGE PIT [ � Depth ".�" .__ _-�j_- ,IJi:am;ier _______________ Num6erT----------------------------- Rock Filled Yes ❑ No 0 Water Table --- Depth r P_ °--------------------------------=•--'-•--Rock Size -------- -'-------------+- ----- Distance to nearest: Well ---------------•------------------------Foundation ---------------.---- Prop. ;Line ----------..-_-__--- REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date ___________________s - ----------- Septic Tank (Specify Requirements)_---,.---_-,--,,.,-.,'...___________ --_---------_ Disp osal Field (Specify Requirements) ---------------------------------------� `-------- -------------------------------------------- i ------------ --' ------------------------ ------ ------------------- # (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 E 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: t "I certify that in' The performance of the work far 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.' r Signed a Owner -------- ------. - ,: BY -- ------- { ------------- Title --------- serif '- ------- - -- {! oth an'owner) f FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY --- �-------------- (P"�------- ---------. DATE- t - ------------------------------------------ BUILDING PERMIT IStUED --- DATE ----- ---- -------------------------- ADDITIONAL COMMENTS _.______________-------------___- -------------------------------------------------------------------------- ---------------------- ------------------------------------------------- ------------------------- ------------------------- -- 8 N.. ----- -=------=-------------•-------------------------------------------------- ------------ --------------------------------------- t , - i _ -'1 -r 1 _�,..__ I ----------------------------------------------------------------- - Final Inspection b {�-_ P Y t�11 Date __fb -- --7 ---- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M