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. _FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT :. y---------- -- ---- ----- �- Permit No: . (Complete in Triplicate) This Permit Expires 1 Year From Date Issued 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: JOB ADDRESS/LOCATION __-_.--- - --. r ` --- <5_ZX1--S7—y--------------------------- _.CENSUS—TRACT ---Jam_-- - ----- Owner's Name ------ Sf e5------ % frt' ------ = -Phone Address ----- � � if ------------------------------------ Cit -----------------------------------=------ �_�-- i � ---- �� `�?:.- Contractor's Name --------- -------------------------------------License # / . = Phone . t Installation will serve: Residence [Apartment House❑ Commercial ❑Trailer Court i❑ I E Motel ❑Other -------------------------------------------- 4 Number of living units:_._______ Number of bedrooms ----:----...Garbage Grinder ___________ Lot Size _ ____ _____________________,______...-. Water.„Supply: Public System and name _______: `49 F- - _________Private ❑ Character of soil to a depth of 3 feet: Sand; Silt❑_'_Clay_:❑_ Peat E] Sandy Loam .E] Clay Loam ❑ ' Hardpan E] .el E] 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'o 'seepage pit permitted if public sewer is available within 200 feet,] PACKAGE TREATMENT [ SEPTIC~ r IC TANK'[ 7 ize-------------�-•---------------------=---------- Liquid Depth ------------._...--------- Capacity-: - ------ Type ---'-==---- -------- Material------------------ 'i N Compartments -------........ Distance to nearest:, Well ------------ ------------------ ----Foundation ,-- _:_--� Prop. Line ----.---.....:...--•-- 00 LEACHING LINE ( ] No. of Lines _._____-- ,_______________ Lengt� of each line----_.___________..._____ Total Length __________.______-___. Da ____- 'D.' Box ------------ Type Filter Materi I ----------------=---- epth Filter Merial ------:-.-----------•----------------------- Distance to nearest: Well -____R_______ _________ Foundation -------------------- __ Property Line ._..__--____._____.___._ SEEPAGE PIT [ ] Depth --------------------Diameter _____ __________ Number- -___ _--_ --- _-- __. Rock Filled Yes ❑ No 0 Water Table Depth ----------------------- ----------- ------------Rock Size ----------- ---=-------------' r Distance to nearest: Well ------------- - -----------------------Foundation ------ - -------- Prop. Line _._........-__•---.--- REPAIR/ADDITION(Prev. Sanitation Permit# ----------------- _________________'_ Date __________________ ..i__________) Septic Tank (Specify Requirements) ---------------;-------------------- _ Disposal Field (Specify f Requirements) --"fi” � C��; ;ti ''s'--------- �6-------X�5 ..... --------------- --------------- -------------------------------------------------------------------------------------------------------------------------- -- ----- R ----------- - --- ------ --------------------- �� j i r` (Draw existing and required addition on reverse side) I hereby certify that I have prepared this dpplication 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 which This permit is issued, 1 shall not employ any person in such manner as to become subject to ork an's Co en'sation laws of.California." i Signed � < f a -------------------------- wOw.r�er . I o , �� BY - i ------------------ ------------------------------------------------------------------- -.Title ----- - ----------------------------- ----------------------- (If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED .BY --------7---I-R=Cb ------------------------------------------- ----------------- DATE ✓ - BU.ILDING.-P.ERMIT.ISSUED------------------------------ ------•--------------------------------:_---------- ---------------------_DATE------ -- ADDITIONAL COMMENTS -- ----------- ------------- -------- --- '-•---. --------------------------- ------------------ - ------------------ ----- ------------------- -- - --------------------------------------------------------- ---- -- -------- - -------------- ---------- ---------- ----------- --- --- - --- - --- - -- - ------------------- ------------- ----- ----- ---- ----------- - ---- --------------------```-'------------------- ---- --------- ---- _-- --- Final Inspecti ----- Date Z�l� SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M �