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a FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ------ -- -------------------------------- ----I------- Permit No. (Complete in Triplicate) f --------------------------------------------------------- J - ---- -------------- � � • I, Date, ssued -c�:-_7` - - _-_--- This Permit Expires ,:.Year From Date Issued.1 Application is hereby made to the San Joaquin Local Health District fora 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: / i0-tc4) JOB ADDRESS/LOCATION .�j.� :•� P-- JA CENSUS TRACT ------------- Owner's NameJI -.8 --------------------------------------------------------------------Phoned ��P Address e ® D .-- C ,,�ft111P, /}Y.E`----------------- City --------------------------------------- Contractor's Name --------License Phone �: . Installation will-serve:_. Residence ❑ Apartment House❑ Commercial [:]Trailer Court :E]Motel ❑ Other![_#`. 4AFWvl -- Di�1'F�l BSO/�1�/!✓�, Number of living units:--- ------ Number of bedrooms -____Garbage Grinder�s2___ Lot Size -��R.9_�iP 'S-�_______________ Water Supply: Public System and name -------------------------------•-•------------------------------------------------- ------Private Character of soil to a depth of 3 feet: Satin Silt[] Cloy ❑ Peat❑ Sandy Loam ❑ Clay Loam Hardpan ❑ Adobe ❑ Fill Material .- o--- 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,p'it permitted if public sewer is available within 200 feet,) C PACKAGE TREATMENT [ l SEPTIC TANK'I _ Si e.e.--------------------- -------- ----------- Liq�?.id Depth ------ -----------------•- tJ Capacity ------------- ------ Type -------------------- Material---------- -- -------- No. Compartments ------------•--------- ,t 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 ------------f---------------_--.-----.---•-- Distance to nearest: Well ------------------------ Foundation ------------------------ Property Line .________---______------ SEEPAGE PIT [ ) Depth -------------------- Diameter ---------------- Number ---------------------------- Rock Filled -Yes ❑ ,No I❑ Wafter Table Depth ------------------------------------------------Rock Size --------------==-------... Distance to nearest: Well --_-_.__.__-----_________________----_Foundation ----- -_ Prop. Line --------..------------ REPAIR/ADDITION -____---__REPAIRADDITION(Prev. Sanitation Permit# ------ --------------------------------- Date --------------------•--•---- ) SepticTank {Specify Requirements) ---- ----------------------------------------------------------------------------------------------------------•---------------------------- i Disposal Field (Specify Requirements) --- a��`--------------------------------- f .� ----- - - --- --- ------------------------------------------ {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: "1 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 becgm@ subject to War an's Compensation laws of California." Signed -,471 ------------ ---- � C (If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY.........T. ----- --------------------------------------------------------- DATE ...... ��>f' 4-4 ----`------ BUILDING PERMIT ISSUED ----------------- ----------------------------------------------------------------------------DATE --- ------- - ---:------------------- ADDITIONAL COMMENTS ----------- -- ------------------- --- ----------------------------------------------------------- - --------------------------- ----------------------------------------------------------------------------------------------- --------- -------------------------.--------- - --- --- - ----------- ---- ----- Id ---- - _--- -------------------- ------------------------------ - I Final Ins ectior't' `' P bY*•^�' �! ------ ------------------ -Da#e ` SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M