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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT 1 �17- ------------------------- (Complete in Triplicate)L,------------------------------ Permit No. -- -1--- ----------JkL- 0------------ This Permit Expires 1 Year From Date Issued Date Issued ----------------------- ------------------------------I 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/ TION -a --4_.__C/ __CENSUS TRACT Owner's Name ------------ ---------_------ ----------------------------I-------------------Phone-23_91��_/_3k/------- Address --------/57-------- da�._ city ----------------------------------------- Contractor's Name -------0 _C�_�_ zzf_zl---------------------------------License Phone Installation will serve: Residence E]Apartment House,0 Commercial ®Trailer Court iEl Motel ❑Other -------------------------------------------- Number of living units_____________ Number of bedrooms ..____-___--Garbage Grinder ------------ Lot Size ------------ ----------- 7 Water Supply: Public System and name ----------------------------------------------------------------------------------------------------------------Private 2r Character of soil to a depth of 3 feet: Sand'K Silt[] Clay E] Peat E] Sandy Loam -E] Clay Loam 0 Hardpan E] Adobe 0 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 f I SEPTIC TANKf ] Size________________________________._______ ---- Liquid Depth ___._.-______.....___.__ Capacity .------------------- Type -- ----------------- Material--------------------- o. Compartments -.................... Ul Distance to nearest: Well ---_______________________________Foundation ----- ---------------- Prop. Line ...................... .- LEACHING LINE No. of Lines ------------------------ Length of each line____-___-__-_______-_ ---- Total Length ------ -------_----------- rn 'D' Box ------------ Type Filter aterial ____________________Depth Filter aterial -------------------------------------------- Distance to nearest: Well --- -------------------- Foundation --------- --- -------- Property Line ........................T Filter SEEPAGE PIT Depth -------------------- Diame r ---------------- Number ------------------ --------- Rock Filled Yes F] No 0 Water Table Depth ------------ -------------------------------Rock Size ---- --------------------------- i Distance to nearest: Well ---- -----------------------------------Foundation -------------------- Prop. Line -....................0 REPAIR/ADDITION(Prev. Sanitation Permit# ----------- -------------------------------- Date ----------- --_----_-----------) Zw Septic Tank (Specify Requirements) ----- ------- ----- -I ------------------------------------------------- ............ Disposal !E Field (Specify Requirements) ------------------------------------------------------------------------------------------------------------------------- ----------- -----------r:77ap,---------4_e---1-1-9---X---------- _C_-___74__.____- 0 '! -- ---------- -------------------------------------------------------------------------------------------------------------------------------------------------------------- (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 Son 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 subject to orkm is Compensation laws of California." . . .. .....Z Signed ---- -- --------------- --- Owner " I - - ---zi>6----------- - - ----------------1---------------- Title ----- ----------------____-------------------- --------------------- By ------ ----&-- ------------------------ (If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY a s --------------------------------------------------- ----------------- DATE 1 L = 7---------------- BUILDING PERMIT ISSUED --- --------------------------------------------------------------------- --------------------------------DATE ------------------------------ ------ ADDITIONALCOMMENTS .---- --------- - --------------------------------------------- ------------------------------ ------------------------------------------- ------------1-111- ----- ---------------------------------------- ---------------- ... . ....... .... . . -- - -------------- - ----- ------ -- ----------- A-Al --------------- -------------- ------ --- - ------------------- - - --------------- ----------- ------------------------ -- ---- --- -- ----------------- -------------------------------------------- -------------------- -------- . ............. ... .. .... --- - -- - -- --------- -- ------- -----------------------------------/------- ---------------- --------- p Inspects ..... .. ---------------------Date --- --—--- -------- -- ----------- Final Inspecti ------ ------ -- -- - -------- -- --- ----i e_ _-.L. ,;i SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M