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F R OFF E U E: APPLICATION FOR SANITATION PERMIT - - . ............ . ------. Permit No. _�_CY-__417 4 (Complete in Triplicate) Date Issued /- 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 /fwith County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION .-------- -- ---h7` �eC4 '------------------------------------------------CENSUS TRACT --------------------_---- Owner's Name ---------------7 �4j G!'J_ A/-------------------------------------- --- Phone LICE - 7 Address ----------------------------------------`41 d--------------------------------------- --. Cit- S o l---------------------- Contractor's Name -------------------- ---------- �U�1E'. '"_-------------------------------------License # --------- ------ Phone Installation will serve: Residence [!�partment House[] Commercial ❑Trailer Court ;❑ Motel [-]Other ------------------------------------------- Number of living units ____ Number of bedrooms _______ ____Garbage Grinder ----W_ Lot Size /y Water Supply: Public System and name -----------5.. <f------__ '_ d_ LGA.____.________________________.__._____.._____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___1�S---X_Q1?y -------- Liquid Depth __f - ........... Capacity � Type ________- --_______ MaterialNo. Com artments ____ Distance Q to nearest: Well _____� _ ____________Foundation ____l42_._________ Prop. Line --.._...... ......._. LEACHING LINE [I�No. of Lines ___ __._�_____________ Length of each line______ _eQ_..__ -______ Total Length .__._.____._.._ 'D' Box --- n--- Type Filter MaterialJ9p7�C- Depth Filter Material _____/_A_..___.._ Distance to nearest: Well ------- n=___ Foundation ------A-) ________ Property Line ----- ................ SEEPAGE PIT [ ] Depth -------------------- Diameter _______________ Number ____________________________ Rock Filled Yes ❑ No i❑ Water Table Depth -----------------------------------------------Rock Size -------------------------------- Distance to nearest: Well ___________________________---___-_--.-Foundation -------------------- Prop. Line _-_-___---_.__.__----- REPAIR/ADDITION(Prev. Sanitation Permit# �_________________ Date _ __= ._Z- _ _____) Septic Tank (Specify Requirements) ---------------------------------------------------1----------•---«-------------------------•-- Disposal Field (Specify Requirements) ____________ -------------------------------------------- 1_/ ______________________ --%--------------------------------------------------------------------------------------------------------------- -------------------------------------------------------------------------- -------------------------------- --------------------------------------------------------------------------------------------------------------------------------- (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 which this permit is issued, I shall not employ any person in such manner as to be7te sv ecr to Wo an' Com ensat'subject- to Wo an ' laws of California." Signed ------ --- -------------------------- Owne By ---------------------- ---------------------------------- Title --------------------------------------------_ -------------------------- (If other than owner) P FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ------- -------------------------------------------------------------. DATE ----� °'�c7 G --- ---------------- - -- -------------- BUILDING PERMIT ISSUED -------DATE ------- i5o - ADDITIONAL COMMENTS .Jl � c /"��f � C'J'_ Q_11i�y-- oaf ------ --- -------- 2174 ------------------------------------------------------ _ -- J ,Final Inspec n b L Dater --._----------------' SAN JOAQUIN/LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M