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' OR OFFICE USE: APPLICATION FOR SANITATION PERMIT ; /`/----?7-=j6-r----------1- 0------ _ Permit No. F . ----------- --------------------------------------------- (Complete in Triplicate)f p P Date Issued ------------------------------------------------------------ This Permit Expires 1 Year From Date Issued r 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 .__ K7------- ---------j_LF- iC H_6"P----CENSUS TRACT --------------•----------- Owner's Name -- Ly - - Phone Address ------S,- --GriZ------------------------------------------------------------------------------• City -------------------------------------------------------------------••------• I Contractor's Name ._11r_11,S_------5. - 7X Phone ---;------------...---------•-y. Installation will serve: Residence [Apartment House❑ Commercial❑Trciiler Court ;❑ Motel ❑Other --------------------------------------------- Number of living units:___I______ Number of bedrooms-.�<,_-----.Garbage Grinder 0p____ Lot Size CRL. ---------�~: Water Supply: Public System and name ------------------ -N-------------------------------------------------------------------------------- -----Private'o----.. s Character of soil to a depth of 3 feet: Sand Silt❑ Clay ❑ Peat❑ Sandy Loam 0 Clay Loam 0 f Hardpan ❑ Adobe'❑ Fill Material ------------ If yes,type____________________________ I (Plot plan, showing size of lot, location of system i6 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[ ASize------------------------------------------------ Liquid Depth ------=-------------,----- .' Capacity -------------------- TYPe------------------- Material---------------------- No. Compartments ---------- ----------- I Distance to nearest: Well ____________________________________Foundation ---------------------- Prop. Line __ ----------------- j LEACHING LINE [ j No. of Lines ------------------------ Length of each line-----------.----------------- Total Length --------------------------- Q' Box ----------- Type Filter Material --------------------Depth Filter Material -------------------------------------.----- I -- Foundation ---------------------- Property Line ---------1--1-1---------- ---------------------------- nearest: Wel! ______________________ _ Pro � SEEPAGE PIT [ ] Depth _____________ r " - Rack Filled Yes No 7 Diameter __-------------- Number ----_ ----------- D Water Table Depth -------------I------i- --------Rock Size -------------------------------- FDistance to nearest: Well ------ ---------�___---------------_-Foundation -------------------- Prop. Line ----_-----------. --- a i i .4 REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date -------------------------._.------I SepticTank (Specify Requirements) -----------------------------------------------------------------------------------------=--------------------I----------------------------- Disposal Field (Specify Requirements) ----D...... V----------- ------ ------------•--------------- I --------------------------------------------------------------=----------------- -------------------- ------------------------------------------------------------------ w ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- (Draw existing and required addition on reverse side) ] 1 hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin 4, 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 "I certify that in the performance of the work for which 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 By ------. - -- --_------��'%`"'"�= Title (Ifo r than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY - DATE -7/77 ----- ----- BUILDINGPERMIT ISSUED --- ------------ ------------------------------------------------------------------------=---- ---------DATE ------------------------------------------- ADDITIONALCOMMENTS -------------- ---------------------------------------------------------------------------------------------------------------------------I------------------- ------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------- --------------------------------- -'----- - - ------ ------ ------- ----------------------------------- - --- - - -- ---- ------- ----------------------------------==------------------------------------------------------ -- - - - --- -- --- --------------------------------- --------------------------------- -------------- ----- --� Final Inspection by: --- ------ ---- -- -------- Date L` SAN JOAQUIN LOCAL HEALTH DISTRICT ----------%------- E. H. 9 1-'68 Rev. 5M.