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FOR OFFICE USE: APPLICATION FOR SANITATION Pr'NT ----- --- ------ --------;------------------------------ Permit No.807!�-`.='_�_ (Complete in Triplicate) ----------I------1_9�----------I----------------------------- Date,Issued -- - -------------- - -------------------------------------- ------------ This Permit ExpirO. I Year From Date Issued 1113"17 3 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: n AJ C,c's-v-, ki A JOB ADDRESS/LOCATIION AX -A1!(Z1qkCfJ,__CENSUS TRACT ---- Owner's Name -------�5Ae_uj ar.-)-----------------------------------------------------------------------------------Phone Address ----------------------------- city -0122- 1_01ca(�a(�---------------- -------------- --------------- Contractor's Name .... ---------------------------------------------------------------License # ------------------------- Phone Installation will serve..': Residence F] Apartment House,0 Commercial :oTrailer Court !,EL Motel F -1 Other ---------------------------------------- Number of living units:---- Number of bedrooms ------------Garbc!ge Grinder ------------ Lot Size __50)UP_0---_-_3'/o _-_O Water Supply: Public System and name ------W-011-------- --------------------------------------- ------------------------------- -Private ZJ Character of soil to a depth of 3 feet: SandR. Silto Clay E] Peat El Sandy Loam -X Clay Loam F] Hardpan F-1 Adobe r-1 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: :1 JNo septic tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT SEPTIC TANK'[ Size.------- ----------- ------------ Liquid Depth ----------:el- --- ------------ 'I Capacity .J�56D------- Type -------------------- Material----------- No. Compartments - 090 T Distance to nearest: Well ------)------11 -------Foundation ---------------------- Prop. Line ------------------- LEACHING LINE No. of Lines ---AUOA)L�------- Length of each line______._-_---------------- Total Length ---------------------------- V Box .----------- Type Filter Material --------------------Depth 'Filter Materi6l -------------------------------------------- V Distance to nearest: Well ------------------------ Foundation ------------------------ Property Line ------------------------ SEEPAGE PIT i! Depth —------- Diameter -2X170--- Number --------------------- Rock Filled Yes F] No a, io 0 -/-Ze--------------------------Rock Size -------------------------------- Water Table Depth Distance to nearest. Well --------------------------Foundation --------- Prop. Line -------•--.------- --- REPAIR/ADDITION ------ ------------- CL - REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date --------------------------------- SepticTank (Specify Requirements) -------------------------------------------------------------Y----------- -------I---------------------------------------------------------- Disposal Field {Specify Requirements) --- '09](11-riDnixis---------z----- ------ ---------------------- ----------------------- ------------------------ -------------------------------------------------------------------------------------------------------------------------------------- ------I------------------------ --------------- ----- ------------------------------------------------------------------------------------------ ------------------------------------- ---- --- ---- (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 Workman's Compensation laws of California." Signed --------------------- ---------------------------------------------- -- ------------------------- Owner By ----------------------------------------------------------------------------------- -------------------- Title ------ ------ --- --------------------------- - -------------------- (if other,than owner) .1 FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY -7rIf- Z-------------------- --------------------------------------- ----------------- DATE ----/f�/- 3-723------------- BUILDING PERMIT ISSUED ----------------------------------DATE ------- - ------------------------------------------------------ - ADDITIONAL COMMENTS --- ------------------------------- -------------- - ------------------- ------------------------- --------------------------------------------------------- ----------------------------------1:------------------------- ----- -------------------------------------- --------------------------------------------------------------------------------------------------------------------------------------------------------------------- Final Inspection by: ___7 _.DatA ------------------------------ ---- --------------------------------------------------------------------- ----------------------------- SAN JOAQUIN LOCAL HFALTH DISTRICT E. H. 9 1-'68 Rev. 5M