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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ----------- ------ ----------- - (Complete in Triplicate) Permit No_ _____ _____. ------------------- - --- Date Issued _911,11 --- -l_7= -- -------- -- 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 with County Ordinance No. 549 a d existing Rules and Regulations: JOB ADDRESS/LOCATION .&� _i _A_eil"In/ __ea_-1 5___x _ __ •ENSUS TRACT ___ Owner's Name -9KQ_- --------------- _ Phone W-6---0-71.1 71. ``__ Address �1-�P-�-L2 City ----- ------------------ - //jf��.,, \ Phone �"/�//// ��//'et Contractor's Name. A�__ ______ ___ ,_�-l__I__ ,_____________License # lel? '� o e _�f-istz_3_�T(-_- Installation will serve: IResidence5lpartment House❑ Commercial ❑Trailer Court I❑ Motel ❑Other -------s--------------------------------------- Number of living units:----J_____ Number of bedrooms __y___.Garboge Grinder ____________ Lot Size Water Supply: Public System and name -------------------------------------------------------------------------------------------------------------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 Rit permitted if public sgwer it available within 200 feet,) ,-- l PACKAGE TREATMENT [ ) SEPTIC TANK:[ c�s's �n9' Size_______ _ 7e3� Liquid Depth ___J!____ Capacity __ U Type __(. ..1_______ Material---Ox . No. Compartments ...................... Distance to nearest: Well ------------------------------------Foundation ---------------------- Prop. Line ...................... LEACHING LINE [ ) No. of Lines ___�____________ Length of each line______6-_Q____-------- Total Length ------ 'D' Box ___�__.____ Type Filter Material __ ____`0_Iu -Depth Fi ter Material ___l_ _�� Dat f, � S / � �--------•--------��---- s ante to nearest: Well ______ Foundfition �l-_ ________-__--_ Property Line ------s�______________ SEEPAGE PIT [ ) Depth _ Diameter _______________ Number ______________________ Rock Filled Yes ❑ No 0 Water Table Depth ---------------------------------------------Rock Size ------------------------------- Distance to nearest: Well ________________________________________Foundation ________________ Prop. Line ________--____-___--__ REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date ----------------------------------) SepticTank (Specify Requirements) -------------------------------------------------------------------------------------------------------------------------------------- Disposal Field (S ecifyRequ rmennts-) � g________ _ + ____�_4�- -�--------a—_ 4 _____ __ _____ ( -- ------------------------ --------------------------------------------------------------------------------------------------------------------------------------- (Draw existing and required addition on reverse side) I hereby certify that 1`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 CS to be suNact to Workman's 1Comp at)6n laws of alifornia." Signed. ` —*-- BY --------------------------------------- --------- Title - ------------------------------------------------- -------------------- (If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY - DATE - -1 BUILDINGPERMIT ISSUED --------------------------------------------------------------------------------------------------- --DATE ------------------------------------------- ADDITIONALCOMMENTS ---- ------------------------------------------------------------------------------------------ `--------------------------- - ------------------------------ �11 1i FinalInspection by: -------------------------------------------------------------------------------------Date - f SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M