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FOR OFFICE USE: r APPLZATION FOR SANITATION PERMIT (Complete in Triplicate) Permit o- ------- -------------- - ------ ---- ------------ --------------- -- -_--._..___.-_________.__ 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 Lcompliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION J (! ^ e �j ------�--N-'---------- --CENSUS TRACT -------------_----------- --A /� Owner's N me "/ e. 1 a l 1V -!-- --� '------ ' - - Pho a t2�.7 _ 7.__'r -- - -------- ------- - - - -- -Cit - Address �-_�- �� --- �`!'' �-N------- -- `-` --------- ---------------------------------- o G � N Y Contractor's Name ------------ ------- ---------------------------------------- ------------------------License # ------------ ----------- Phone --------------------_-------- Installation will serve: Residence AApartment House❑ Commercial []Trailer Court ;❑ Motel ❑Other -------------------------------------------- Number ------------ ---------------- --Number of living units:----/----- Number of bedrooms _____Garbage Grinder xES' Lot Size __ _'___ /� C res w 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;K Fill Material ------------ If yes, type ---------------------------- (Plot --._._-_._-_-..________(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 pub sewer r i available within 200 feet,) 'Mop / 1/1 I / PACKAGE TREATMENT [ ] SEPTIC TANK:[ ] Size_ __X __ _- .____ �__. Liquid Depth _____ ____________ _____ N 2 r c T/-C I-C V;, Capacity _-_-�__�-d,__ Type __Q__�S_._z�Materiall:_ __________�� Compartments Distance to nearest: Well __------- _______________________Founda�ion._ ___-_ --- --------- __ -_--__-__ Prop. Line _ ...... LEACHING LINE [ ] No. of Lines -------------- Length of each line ___________ ______ -__ Total Length -----J__8'_J........__ ---------- `f/ It 'D' BoxY�_S-_-_ Type Filter Material L-_a�s�_____Depth Filter Material _--_-_ _______________________ / / / Distance to nearest: Well -----Ca ......., Foundation -__-4�----.______ Property Line ----fo . SEEPAGE PIT [ ) Depth __ ______ Diameter --_ Number __-----Z_______________ Rock Filled Yes EK No i❑ Water Table Depth ----------------------------—------------_-•_Rock Size _2---�'+- s: Distance to nearest: Well -----_/__AI......--......-----------Foundation ---A -.-__ Prop. Line _-__ ....... REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date __________________________________) Septic Tank (Specify Requirements) -------------------- ------------------------------------------ ------------• --------------------r _--------------------------- Disposal Field (Specify Requirements) _____-_____ _________.________________________________.------ -----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------•---- ----------------------------------------------------------- ------------------------------------------------"------------------------------------------ ------------------------------------- ---------- (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 become su ject t kmg�'s Co pens do s of California." Signed ---- -- . - r.-4al � Owner BY ------ ---------------------------------------------------------------- ---------------------------- Title .----------------------------- ---------------------------------- (If other than owner) FOR DEPARTME T USE O Y APPLICATION ACCEPTED BY p._--_____-__ __ DATE ------ -- ------------- 1 BUILDING PERMIT ISSUED _.-__-_-._-__. DATE --_-_-_-_-.--____-____--._ ADDITIONAL COMMENTS __ ____ __ - _ -. -- ------____ ---_ ________ __ ____ __ ______ -------- --- --------- ��-•fit �- '`-2 `< ... �' "G9':- ^ --------------------------------------------------------- - .. --- ------- - - ------- -- r, ✓__ -----------------------' ., --------------------------------•-----------------------•- - --------------------------------------------------------------- ------- - Final Inspection by: = - ` J= " Date --- ------ --------- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M