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OR OFFICE,,4JSE: APPLICATION FOR SANITATION PERMIT - 7/-/�5- --- -- --- t1 Permit No. ------------- �/ (Complete in Triplicate) =---------------- -- --------------- Date Issued --------------------------------- 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 maylg,,�ggmpliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION ._7_ �---11c,-_-�-V-S---� --- � '� CENSUS TRACT __________________________ Of Owner's Name ------ _Phone v Address ----- — _ 1/ X19, ---------- City --- 's� /1 _ — --------------------- ----------- ------------------- -------•--- .X. Contractor's Name ______ ____ _�_/✓��.�`'��-__�1.1�.,t��_ ____.License �c�� --_ Phoned2.4=3�.=__�4'�._... Installation will serve: Residence eApartment House❑ Commercial ❑Trailer Court ❑ ii Motel ❑Other -------------------------------------------- Number of living units:---/------- Number of bedrooms --,3-----Garbage Grinder .-_ ---- Lot Size -- - f ------ 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 pit permitte if ybblic sew r is availablwithin 200 feet,)rte- �/ PACKAGE TREATMENT [ ] SEPTIC TANK:[e Size_ __11___/_x--- - '�--- Liquid Depth AA9 PACKAGE 00 Capacity/oW-__,___ Typet '_,A _ Material441 No. Compartments _______________ i o Distance to nearest: Well ___i/ -------------F__Jounclation --le)------------- Prop. Line As.lp......... �j e LEACHING LINE [43/No. of Lines _ ____-_________ Length of each line---��- ________:__ Total Length C_Z4P.............. ,n 'D' Box �-_ Type Filter Material �� Depth-filter _,f?----------------------------------- I �I. - - / Distance. 6-nearest:'WAR:_ Q _ ____ __ Foundation /O_ _ ---_____ _ Property Line A-_iP------.-__.._ .r} r* - _ .V - - Number ____________ Rock Filled Yes ❑ No i❑ t SEEPAGE PIT ] Depth g__- '------- Diameter N Water Table Depth - ----------------------Rock Size -------------------------_---- f.._, 1-, Dis,`tance to.nearest: Well ------ ------------------------------Foundation -------------------- Prop. Line ...................... REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date ---------------------------------- Septic Tank (Specify Requirements) ------ -- - -- --- -------- - --- -------- --------- ----- --------- ----------------- ------------ Disposal Field (Specify Requirements) ---------•------------------------------------------------------------------i=-----•------------------------------------------------- ----------- ------I--------------------------=----------------------- -------------------------------------------------------------------- -------------------------------1--------- .---.--------- ------------------'--------------------------- ---- -------- ------------------------------------------------------------------------------------------------ ------------------------------ - ;Draw existing and required addition on reverse side) I hereby certify that>Ihave prepareiL,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�i nature certifies the following: "I certify',tha 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 ------ t ` `''` --- Title _ f .0 ctX /J ------------- -- i (If other than owner) '^ FOR DEPARTMENT USE ONLY APPLICA IOY ACCEPTED BY DATE -- ---- ---------- BUILDIN ..PERMIT ISSUED##i - -- - --- --- ---- -------- -- ---------------------------------------DATE ------- ----------------------------- ADDITIONALCOMMENTS i mt--------------------•--- ---------------------------------------------•----------------------------- ------------•--------------- -- ---------------- -------------------------------------------------------------------------=------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------ -- -- ---=-- ---------- ----------------------------------------------------------------------------------------------------- --------------------------------------------- - - - - - - - - - - - - - - - - - - Final Inspection b 4 c2 =-'-------------------------------------------- ------------------ .:Date '- = � p Y SAN JOAQUIN LOCAL HEALTH DISTRICT E.H. 9 1-'68 Rev. 5M