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FOR oFElcE USE: APPLICATION FOR SANITATION PERMIT ' ------------ ------ -------------1l:_a0------------ �— ti r ewr ..r (Complete in Triplicate) Permit No ______________7Z_ -- ----- -�,�-------------------------------------------- This Permit Expires 1 Year From Date Issued bate Issued --------------------------------- ---------------------- Application is hereby made to the San Joaquin Local Health District for a_wpermit_to_construct and install the ,work herein described. This application is m1ade`in compliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LO T ON /7 -'�-I=--.=1`�'=3-- L�% -t'72--= -}- ---------------CENSUS TRACT ----------------------.._. ► Owner's. Name __ �� �r•,,C� /� --. 12.1------- -/---�--' --- - ------------------------------------------------------�-'---- -- Phone'�------------------------- - -- Address -{+�--/" - ---'__! __._ 3'G---------------------- ------ -- CItY'-='�' -- '�..,.�z-.�.----"=--...___..ate-------•-•-- Contractor's Name ----1- _-- a -'-- -------------------License #- -f --- Phone ___-------�_- ---- -------------------- - - installation will serve: ResidenceVApartment House❑ Commercial :❑Trailer Court i❑ I / Motel r-1Other ---------------------------- i -" Number of living units:____/_____ Number of "' drooms. ____Garbage Grinder __ ,Lot Size -. -�s -f___._ .,�.er �. „� ..��i ,mss- ' t Water Supply: Public System..and`name�_- ��- . 0-------- -------------.-----�-"- ------Private ❑ Character of soil to-a depth-of 3 feet: Sand'El Silt fl Clay ❑ Peat❑ Sandy-Coam ❑ Clay Loam ;❑ I =•," Hardpan ❑ Adob.*%7 Fill Material -------- If Yes,type ------------•--------------- ell (Plot plan, showing size of lot, location of system in ielbtlon to wells buildingsl%tc. must be placed on reverse side.) NEW INSTALLATION: {No septic tank,orseepage pit permitted_;if,'pUb lici'c sewer is available within 200 feet,] � PACKAGE TREATMENT [ ] SEPTIC TANK [ ] Size--------_ ------------------------ =------------------- ---- Liquid Depth -------------------------- capacity -------------------- Type--------------------- Material ------ ---- -------- No. Compartments ------------------ X11 Distance to nearest. Well --------------------------- —]-.-Foundation ---------------------- Prop. Line ----------_---__ LEACHING LINE {-] No. of Lines _______________________ Length of each line---.-.---------------------- Total Length ----------------------------- 'D' ___-______-___________-_•__'D' Box ------------ Type Filter Material ---------------- ---Depth Filter Material --.-----------------.---------------........ Distance to nearest: Well ________________________ Foundation ------------------------ Property Line _.________________-_.___ } SEEPAGE PIT [ ] Depth __ _________________ Diameter ---------------- Number ---------------------------- Rork Filled Yes ❑ No �❑ Water Table Depth ---------------------------- Rock Size_ Distance to nearest: Well --------------------_--------------------FoundationProp. Line -----•-•--•------•---- REPAIR/ADb[TION(Prey. Sanitation Permit# --------------------------- ---------- Date _____-__-__-_____________________] Septic Tank {Specify Requirements] # I -------- ----- ----------------------------- --- ------- ; Disposal Field (Specify Requirements) -- _- _______ c __��1 Liu_ _____• - ------------- --------------------------------- -------------- ------------- - ------------------------------------------------- (Draw existing and required addition ion reverse side) f r ' I hereby certify that I have prepared this application and that the wo;.k<will be done in accordance with San Joaquin County Ordinances, State Laws, and Rules and Regulations of the San Jocquin Local health District. Home owner or licen- sed agents signature certifies the following: , V__' _ "I certify that in the performance of the work for which this pEermit is issued„I shall not employ any person in such manner as to become subject to Workman's Compensation laws of California." Si rd - B f 4 Owner ------ Title owner)( j FOR DEPARTMENT-USE-ONLY_ APPLICATION ACCEPTED BY y = - € 'DATE 6 --------------- BUILDING PERMIT ISSUED ----- ------------------------------- ------------------------------------------- ----A--- !,°DATE E- ---------------- ADDITIONAL COMMENTS __________________________ --------------J .. --i------------------------------------ I _________________________________________________________________________________________________ ____________________.____________________ ____y___.____.--------. _----_-- ________. y.. i _____________________ `-------__ _ _ f _ _ Final Inspection b ------------------•r-�_ _ � P. t r D ; Y- �-•-------------------------------------------�------------------------------ {------=,--ate --- �-� . .SAN.JOAQUIN_LOCAL,HEALTH DISTRICT, J E. H. 9 1-'68 Rev. 5M