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FOR OFFICE-USE: _ I APPLICATION FOR SANITATION PERMIT 4;._ 'b 517 ,�.--------------- (Complatein Triplicate) Permit No: -_7 --__Arl __ , ' __________ This Permit Expires i Year From Date Issued 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: J08 ADDRESS/LOCATION . -Vic--- --- ✓ "`�''` (/r ----------------------CENSUS TRACT --------------_----- Owner's NameG_h_ _L�s - 4 -LtCU------------------------- ----- -- -•----- Phone -------------------••----- • °t �J , Address ----- ---- n_--:---�--- .-------------------------------------------------------------- City ---------------------•-----------------•-- Contractor's Name --------- "'---------------------------------------------------------------License # ------- - .--- ---------- Phone ----------- ---------------- Installation will serve: Residence ❑Apartment House❑ Commercial :❑Trailer Court ❑ :- I Motel ❑ Other ----)_tk---'------------------------------ I .g units:.__. �.er Number of Ii I____-- Numbof bedrooms -__ _-_Garbage Grinder _____.___-__ Lot Size __________________. ------------ r t - . 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:❑- Fill Material ------------ If yes,type =______________________ (Plot-plan, showing size-of l.ot,_Locati.on -of,system in relation to wells, buildings, etc. must be placed on reverse side.) NEW INSTALLATION: ; (No septic tank or sa pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT } { J SEPTIC TANK'[eeps Size------------------------------------------------ Liquid Depth ------------------------ Type ----------------------TYPe 90424�l --------- Material_4fc_e 1`�_ No. Compartments __!4n__ ky IDistance to nearest: Well ---(_�_/-f--_ Q--------•--------Foundation ---- ----------------- Prop. Line --.- ----------------- • � r. LEACHING LINE : [ No. of Lines ---A---------------- Length of each line______ Total Length 'D' Box __ _ Type Filter Material - -Depth Filter Material _--_-_____--��J -------------•-•-------- Distance to n rest: Well --- -/ Foundation ------------------------ Property Line ___-______-. 4 Depth -- -- ----- = et -- ---- bey- l- -- ------ -- ock 1 es K... € Water a pt --- -- --- --- -- -- ----- ------ ----- -- o a --- -------- -- ------------- Distance to n st: ell R__ ----- - ---------F dati Prop. Line ------------------ �s REPAfR./ADDITION(PL-;. Sanitation Permit# -------------------------------------------- bate Septic Tank (p cify Requirements) __-------------_-----------I-_____________ s ----------------------------------------------------- - - 4 Disposal Field; (Specify Requirements) -______'_____ _ ' ----------------- -= — -= - ---------- - (Draw existing and required addition on reverse side)._ - hereb cern that Irhaveprepared _ papplication � -��- - Y certify pre ared this 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, I shall not employ any person in such manner + as to become sub'e- #oI Workman's Compensation laws of California." Signed ------ ------------- -------•----=--- --------- Owner BY =---- ------------------------------------------------------------------------------------- Title ----------------------------------------------------- (If other than owner) R DEPARTMENT USE ONLY APPLICATION ACCEPTED BY = J BATE 7 .2 - 2 - ----------------------- - ------------------- BUILDING PERMIT ISSUED ---- -----------------------------DATE --ADDITIONAL COMMENTS -- --------------- ------------ - - ----------------------------------- ----- -------------------------------------------------- ------------------------------------------ -- ----------------------------- ----------------------------- - --------- -- ----------------------------------- ------------Final Inspection by - rr - Date--------- ---------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'6$ Rev. 5M. ,