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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT 10 - 8 -1 1 = ------------ _ _ / G k ,. (Complete in Triplicate) Permit No: .(�4_-'�_..___. ` A--- --------------- Date Issued J--16__-4) --------------------------it ------ ---------------- 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 co/m�pliance/with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCA ION `1r'_ _ _.__/-U., Y� _1��_____ --------------CENSUS TRACT .......................... Owner's Name !ZQ�'j------- -----/-�✓M. � � K,E7�( - Phone -1-.�ZL�Z�.� Address --- ---_- ------- --- ---------------------------------------------------City --- 7 v-_ceCxcrAl-------Com`--' ................ Contractor's Name :*____.5pl_l,_s...././_V_-:____.License # Phone . (10(?P0_1,7..._ Installation will serve: Residence Apartment House❑ Commercial ❑Trailer Court ❑ Motel ❑Other ----------------------------- ------ Number of living units:--A------ Number of bedrooms __3......Garbage Grinder _WC-- Lot Size .01--1 �-c------- ------ Water Supply: Public System and name -------------------------------------------------------------- ---- - ----- •---• --------•------Private f$ Character of soil to a depth of 3 feet: Sand'F] Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam,'❑ Hardpan ❑ AdobeX 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 [ ] SEPTIC TANK f ] Size------------------------------------------------ Liquid Depth .......................... Capacity ------------- Type -------------------- Material--- ------------ --- No. Compartments --- ---- .._. Distance to nearest: Well ---------------------------------...Foundation -------------- ------- Prop.Line ...................... LEACHING LINE [ ) No. of Lines ------------------------ Length of each line________________________ Total Length ---------_.-.-__.-_.__.--__- 'D' Box ------------ Type Filter Material _____________Depth Filter Material'........................ Distance to nearest: Well ________________________ Foundation ------------------------ Property Line ........................ SEEPAGE PIT [ j Depth ___________________ Diameter ________________ Number ________-_ ----------------- Rock Filled Yes '❑ No 0 Water Table Depth ------------------------------------------------Rock Size -------------------------------- Distance to nearest: Well _______________________________ ____Foundation ._.. --------------- Prop. Line ...................... REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date -_____--______--__--___-__-___-__-) Septic Tank (Specify Requirements) ------------------------------ ----------- - ------------ -------- 4 .......0,_- _ - -_-.-.------ Di osal Field (Specify,Requirements) • u / -------------------------------- --------------- ----------- --------------------- - ---------------------------- ----- (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 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 Whkh this permit is issued, I shall not employ any person in such manner as to bec a ubject to W man' Com nsation laws of California." Signed -- --- ----- Owner BY -- ------ -- ---- -L- _-- Title -- ----------- -- - - - ---- ----- ------------ -- (If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY'-- ----- DATE -- I - -------------------- _ . ---------- ---------- BUILDING PERMIT ISSUED------------- ------------ --------------DATE ------------------------------------------ ADDITIONALCOMMENTS ------------------------------------------------------=------------------------------------------------------------------------------------------------------- ------------------------------------------------------------ ------------------------------------- -------------- --- - ----- .,,� Final Inspection by: -st1- - Date------------------ - SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M