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FOR OFFICE USE: SANITATION FOR PERMIT Permit No. ?—- 9--L APPLICATION /��/�---�---- ------------- -------- (Complete in Triplicate) , ! P Date Issued 16-3� --------------------------------------------------------- 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 and existing Rules and Regulations: JOB ADDRESS/LOC TION __ l__ '`-_____, !Y,r�t�L__, .+-- - .� -- --0�-� OWCENSUS TRACT _________________________ Owner's Na „�------ -- - ---------------------a -----------------------_- -------------------Phone -------------------------------- Address ----7 ��c'-F- b - c City �� , ----�� "`------------- -------•------ Contractor's Name ---C -1 -.License # hone Installation will serve: Residence ❑ Apartment House❑ Commercial ❑Trailer Court I Motel ❑Other ------ ---��'`-- Number of living units:_____(____ Number of bedrooms _____Garbage Grinder ------------ Lot Size ------- -------- ------ ---------- Water Supply: Public System and name ------------------------------------ ------------------------------------------------------------•------------Private C;i` Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay Peat❑ Sandy Loam ❑ Clay Loam❑ Hardpan ❑ Adobe❑ Fill Material ____________ If yes,type____________________________ (PI'ot 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__ � ___ __g__X__�__________ Liquid Depth ---``?_...______________ 00 Capacity _ x7p_—9y'pe Material-_- No. Comparitnents ___. "_.___..___ 5 Distance to nearest:_ 01Well _____SP---I_________________Foundation __-___C-�____---__ Prop. Line ------5_..___--_____. f LEACHING LINE [ No. of Lines ______I_____________ Length of each line______ ----- Total Length __L_d-o•- __----- 'D' Box ------- Type Filter Material ______S___ ___Depth Filter Material ---.i'_Q_._`_`_____________________________ t Distance to nearest. Well ----- _____ Foundation -----LO__!--------- Property Line _____ ______________ SEEPAGE PIT [ Depth ---._____�:!�^_� Diameter ---- Number _______ ---------- Rock Filled Yes ' No C] Water Table Depth ---------------------)-Q-4P- r--------------Rock Size ------1--1_'V--=r-- 3------ 1) i Distance to nearest: Well -______�_ ?_ '___ ___________________Foundation ___L_�?-t___.____ Prop. Line ___ ______.._.__ REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date _________________-______________-_) Septic Tank (Specify Requirements) ------------------ ----- ---------- -•--•----------------------«.------------------------ `'' Disposal Field (Specify Requirements) -------------------------------------------------------------- ----------------------------------------------------•- -------•------- --------------------------------------------------- ------------------------------------------------------------------------------- ---------------------------------------------=------------------------ -----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------•-----------•--- (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, 1 shall not employ any person in such manner as to become subject to Workman's Compensation laws of California." Signed ----------------------------------- --------- Owner�r BY ------------------------------------------- n --_ --------- Title - Z (If other than owner) FOR DEPARTMENT USE ONLY APPLICnON ACCEPTED BY -------------------------------------------------------------------- DATE _��_"�- .................. BUILDINGPERMIT ISSUED --- ----------------------------------------- --------------------------DATE ------------------------------------------- ADDITIONALCOMMENTS -------------------------------------- -------------------------------------------------------------------- -------------------------------------- ----------- -------------------•------- ---------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------ ---------------------------------------------------- --------------------- ------------------------------------------ ------------------------------------------------------------------- - - - - - - - - - - - - ----- ---------- -- --------- - ------------- - -- ------------------------------------- ---- ----- ----- --- ------ ---- - -- - - -- Final Inspection by: '`� ,- --------------- ---------------•--- -------------------Date 1� ---�- ------------ SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M