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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ------------------------ ------------------ � (Complete in Triplicate) Permit No. -- Date Issued 7= --------____'_-`___.______---_-------------- 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 OrdinaniceiNo. 549 and existing Rules and-Regulatiom: JOB ADDRESS/LOC/4 ION 1 C?--- ------- � --------------------------UL-2,4- --CENSUS T ---------- Owner's -- ----Owner's Name ze-ica-'--- -- ---- --------------------------------------- - - hone -- Address ------------G - ---yarn ------ A J -- - -- ----- ----- City --------- . ......... ................. Contractor's Name ___ ______ IL�vs-��=✓__ -__�_ _ __ _�__ License # "one _...._ Installation will serve: Residence ` Apartment House❑ Commercial ❑Trailer Court C] Motel ❑Other ----- �...,.., Number of living units:__________ Number of Xbek,00ms Garb ge d r . -___-_ ize _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 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 [ ] Size------------------------------------------------ Liquid Depth _----___-__-_-_--__..._.__ Capacity ------------------- Type -------------------- Material---------------------- No. Compartments ...................... Q 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 [ ] 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# ------_--------_____________________________ D te _-_-_-________-_----___-__________) Septic Tank (Specify Requirements) -------- ------------ --- ------- ------- "e - --- ------ ----------------------------------------------------------- Disposal Field (Specify Requirements) __ ----- --------- ---------- ---------- X-- --`- / ------.- ----------------------------- ---------------------------------------- ----------------------------------------------------------------------------------------------- ------------------------------•------- raw 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 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 -------------------- = .x "l- - �^". =-4 - Title -- -------------------------------------- (If other than owner) At. - 01E E ONLY APPLICATION ACCEPTED BY F_ __ r_-__--_ BUILDING PERMIT ISSUED ------------------------------------------------------ ----------- --------------------------------------DATE ---------- ADDITIONALCOMMENTS _------------------------------- - ---------------------------------------------------------------------------.....------------ --- ------------------------------------------- ---------------- ------------------ --------------------------- ---------------------- ------------------------97:6 � ------------------ --------------------------------- --- - ---------------- ----- ----------------------------------- -------------------- ------- - /-------------------- - - - - - --------------------- ------- - - Final Ins ection b __-__--___Date __. ___---- __. _ ___._______ SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M