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FOR OFFICE USE: \ APPLICATION FOR SANITATION PERMIT �j p ----------------- (E'omplee in Triplicate) Permit No. ---------=------------ -- Date Issued/U_-ls. --------------------- ----------------------- 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/LO,C�A*sTION _ /�,_/Y'__Gy / _ __P �_7___, _ 1- __Lf�lf,� U TRACT --------------____________ Owner's Name __!�" �'_��f -K/lva/M__!""---------------- --------------------------------- =I-------- ---------Ph ne ------------------------------------ Address / /®+L.�'•' /� G /a _,__. City ---- ------------------------------------ Contractor's Name __:_/_�_ /__C>-__'' ��/,Cry'------------------------- #� Installation Will serve: Residence Apartment House,❑ Commercial ❑Trailer Court ;❑ Motel ❑Other ----------------------------------------- Number of living `r?nits:---- Number of bedroomg _------Garbage Grinder/y Lot Size r- - -= ......... � f 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 _____________________--_(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 ppblic sewer is available within 200 feet,) r PACKAGE TREATMENT SEPTIC T NK Size_ { 7 � --------- -- Liquid Depth Capacity __PP-__,-_ Type /44 Material �s� _�____ No. Compartments _-Z............... Distance to nearest: Well ----74�___--------------------Foundation _/_ ____________ Prop. Line -_sf�------------- / LEACHING LINE ----------No. of Lines ------�-----_--_--- Length of each line_____ +_� Total Length - --- D' Box _ 0 _ Type Filter Material fJ-X_0.Depth Filter Material /f '______________________________� 60 Distance to nearest: Well �I�---------- aL Property ---,�1 Foundation ___________ Pro er Line 6 SEEPAGE PIT Depth �7f'�f �__ Diameter . Number __ ------------------ Rock Filled Yes '( No 0 Water Table Depth -------Id-10__ ______________________•Rock Size ... ----------- -- --- Distance to nearest: Well �__r � _�________________Foundation . _ �____ Prop. Line ___`4.._........ REPAIR/A136ION(Prev. Sanitation Permit# ____________________________________________ Date ________-_______-__-__•-__________) SepticTank (Specify Requirements) ------------------- ----------------------------------------------------------------------------------------------------------------- Disposal FIVId'' (Specify Requirements) ---••----------------------------------------------3-----------------------------------------------------•-----•---------•----------- ----- -< - ,iF --------- --- - --------- ---- -- -- -- -------- ------ '- - 4-- , -------------------------- �-------------------------------------------- ffn- ---------- ----- - -------- --------------- ---- -------- (Draw existing and required ad�tion on revel side) I hereby certify t at'1 have prepared this application an'd that the &od2ong' accordance with San Joaquin County Ordinance s to Laws, and Rules and Regulations of the Saiz Joaquin Loci Health District. Home owner or licen- sed agents signature cer fies the following: "I certify that in the perrmance 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 ----- (If er than owner) FOR D PAR ENT USE ONLY APPLICATION ACCEPTED BY ------ �'f -------------------------------------------------------- DATE _/___d:�lr _----.---.. tf? BUILDING PERMIT ISSUE_ t- ------ -- ---------------------- ------------------------------ ----------------------DATE -------------•----- ----------------------- ADDITIONALCOMMENTS ---'-------------- - ------------------------------------------------- ---- ----------------------------- ------------------------ ..... .......... ---------------------------------Ir--------------- --------•-------------------------------------------------------------------------------------------- -------------------------- ------------------- --------------------------- - --------------------------------------------------------------------------------------------------- -------- ---- ---------------------------------------- ------ Final Inspection by -- - 1 -------- ----------------------------------------------------------------------- Date /� t - =- rj----------- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M ` `