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FOR OFFICE USE: APPLICATION,FOR SANITATION PERMIT 4=------- � --- ------------•- ------------------ Permit No: /2-3-A---(Complete in Triplicate) --------------- -- �` This Permit Expires 1 Year From Date Issued 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/LOCATION f_-/_�nAld ..1 `! _!__�_�_t-__.(_1__Y__ -- - -F.i'-�! -?-1../...------CENSUS TRACT -_-___________________----7 Owner's Name//^^�� l ' -^'---- 1-`�-1- ^f 1/ ,----- --- -��--�_�------------ Phone'_"7_- -l Address -----40_0--- -- __l--- -' F t-�, -p- -1-1_ r r --------------- City _� 7 --------04.1--------------------- Contractor's Name _____ -_14__"t.5f4--__�___S_c_�.S-_____�_/VC__-License # /1174Z l---- Phone4k-673-9-3-1. Installation will serve: Residents VApartment House❑ Commercial ❑Trailer Court i❑ Motel ❑Other------------------------------------------- Number of living units:_ __ __,__ Number of bedrooms __*_5-.....Garbage Grinder ------------ Lot Size __/-C-ZEi9_ E----__--.--- Water Supply: Public System and name -----------------------------------------------•------------- •------------------------------------------Private ` Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam X 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 tan4 or seepage pit permitted if public sewer is available within 200 feet,) O PACKAGE TREATMENT [ ] SEPTIC TXNK 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 [ ] Depth _____--------------- Diameter ________________ Number ---------------------------- Rock Filled Yes ❑ No i❑ Water Tablet Depth ------------------------------------------------Rock Size ..------------- ---------------- Distance to nearest: Well ________________________________________Foundation -------------------- Prop. Line ______-----___-_._---. REPAIR/ADDITION(Prev. Sanitation Permit# ____________________________________________ Date ______________-__-_________..._.__) Septic Tank (Specify Requirements) ------------------------------------------------------------------------------------------------------------------------------ -------•-••- __ Disposal Field (Specify Requirements) -D_D.v1_v.A_L-. 1_______ 3.0__-----Leg_c_t4--_____L1_ _l_f_--------------- ------------------------------------------------------------------------------------------------------------------- Y------------------------------------------------------------6------------------------ ------------------------------------------------------------------------------------------ - - -- ------- -_---------------------------- - - - - - -------------------------------------- ------ (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 becosu Iect to Wor an s CImpensation laws of California." Sign ------ ---- l - i . Owner = ---= --- ----BY - on - _ Title ji� --., ----------------------------------- (If -------- --------- --------- (If other•than owner) O PARTMENT USE ONLY --- -- - APPLICATION ACCEPTED BY ------ - - - - ----- ---------------- -- --------------------------------. DATE __- ----------------- --- - - BUILDING PERMIT ISSUED -------- -- --------- ---------------------------- -------------------- -- -----DATE ------------ ---------------------- ADDITIONALCOMMENTS ------ ---- ------- ----- --- ---- -- --------------------------------------- ------------------------------------------------------- ------- ---------- -- ----------- ---- .� ---- --- -- - -. - --------------------------------------------- ------ -�- -- ----- - Final Inspection by: � _ _ -_ _ -__ _ - _ . -__ _____-_Dater '1E -------------------------------- SAN -._ SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M