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FOR OFFICE USE: APPLICATION 'FOR SANITATION PERMIT --------- ------ ---------------- ---------------- Permit No. � (Comp'tete in Triplicate) - I Date Issued ---- : r�L . This Permit Expires 1 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. JOB ADDRESS/LOCATION ...... ------�-- JI"�/.V,6- lL'�-------- ------------------- - - ___CENSUS TRACT --__.____________.____.. Owner's Name ._Z)__A e_S------ F `------------------------------------------------------------- -------Phone ------------------------------------ Address -------- AM ------------------------------=------------------------------------ ------------ City _411VA". -V--------------------------------------------------- Contractor's Name ---Ike S,�-1-74 ff-----Mor-- P License # 11>71MO____ Phone ------ Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑Trailer Court l❑ Motel ❑ Other -------------------------------------------- Number of living units ----- Number of bedrooms ________Garbage Grinder )V6%__ Lot Size _-,/d�' =----------------- a R 1 � Water Supply: Public System and name ---------------------------------•------------------- ----------------------------- •------------------Private ❑ Character of soil to a depth of'3 feet: Sand'❑ Silt❑ Clay ❑ Peat❑ Sandy'Loam ❑ Clay Loam ❑ Hardpan ❑,. 'Adobe X 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 [ ]R SEPTIC TANK Size------------------------------------------------ Liquid Depth ---------------- ------ l I -- --��Capacity -------- ----------- Type -------------------- Material---------------------- No. Compartments ----- --------------- Distance to nearest: Well 6Jre-�__ .►-------Foundation ---------------------- Prop. Line ---------------_______ �? LEACHING LINE [ ] No. of Lines -------------------------- Length of each line-------------- -------------- Total Length ---------------------------- ------------------ -----.----.----------.----- _D' Box - --------- Type Filter Material Depth Filter Materia Distance to nearest: Well 4Y___ ___ Foundation Property Line ___________ ___ SEEPAGE PIT [ ] Depth ____________________ Diameter ______«________ Number _______.______._.__-__---- Rock Filled Yes ❑ No i❑ `N Water Table Depth -----------------------------------------------..Rock Size ------------------ Distance to nearest: Well P_r- �QQ_--z------Foundation _____________ _____ Prop. Line __.._______ ......... ` REPAIR/ADDITION(Prev. Sanitation Permit# -- --- ----------------------------------- Date ---,------------------------------) SepticTank (Specify Requirements) ------------------- -----------------=------------r--------------------------------------------------------- _ ------------------------•--- Disposal Field (Specify Requirements) ----- P--------7'�-�---PF_ '_2: --- /'lU l�llltG?------ ---- ��=::�' �4r /` i---{--7_ft_.....aR11v1--- /--oe ��"�_�`�sy_<7 2 +__--Cl/`' �?`v �' - ,Qraol�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 I 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: 1 "I certify that in the performance of the work for which this permit,is issued, I shall not employ any person in such manner i as to become subject to Workman's Compensation laws of California." Signed - . Owner oBy ------------------------------- ----- - - =-------------- ---- Title � ----- a (If otherwner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY -- -- - ----- DATE ------- - - - BUILDING PERMIT ISSUED ------------ -- ----- - ------------- -----DATE -------- ----�- ------ ADDITIONAL COMMENTS --- � zI--------------------------------- ----------------------------------------- ------ - ----------------------------------------------- ------------------------------------------ ------------------------------------------------------------------------------------------------------------- ----------------------------------------- ------------- ------ ----------------------------------------------------------------------------------------------------------------------------------------- ----------------------------------------------------- -- - - ----- Final Inspection by: ------------------ - ------ - --------------------------------'--------------------------------------.Date --- ----�� i ----- SAN JOAQUIN LOCAL HEALTH DISTRICT r ` E. H. 9 1-'68 Rev. 5M "'