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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT - --------------------->----- t=----------------- Permit No. i (Complete in Triplicate) ------- --- -- - �� /�, 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 compliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION ._--_____c-__-��_�J�______%C''-___.�/�-'-'_f�'�r__-__ -. _______________-CENSUS TRACT ____�-��_- Owner's Name ---------------pp-lj/ " --------------- ----------Phone r' r '•� Address ----------------- � City 'c> /9 u I'/),-Rd � �r i r --------------------------- ----- -. -------- Contractor's Name __ __- _ ---------------------------------------------------License ------------------------ Phone '____"_____---" / Installation will serve: Residence ]'Apartment House❑ Commercial"0Trailer Court i❑ Motel ❑Other ------------------------------------------- Number of living units:------ ---- Number of bedrooms ._3......Garbage Grinder __%* --_ Lot Size ______________ Water Supply: Public System and name -----------•---------------------------------------------------------------------------------------------------Private EZ 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 _-__-_-__________________(Plot plan, showing size of lot, location of s stem in relation to wells, buildings, etc. must be placed on reverse side.) �y NEW INSTALLATION: (No septic tank or see age pit permitted if public sewer is avail ible within 200 feet,) PACKAGE TREATMENT l ] SEPTIC TANK f ] Size------------------------------------------------ Liquid Depth -____________-_-.__...._- Capacity ------------------ Type -------------------- Materi,9l--------------------- No. Compartments ---------------------- (^` Distance to nearesti ell __________ Prop. Line ...................... . ----------------------------•--•----Foundation ---- ----- LEACHING LINE [ ] No. of Lines ______ ___ ____ __ Length of each line-_- __- -______ Total Length ______--___-. 'D' Box -__-_----__ Typlter Material :__ __ ____,Depth Filter aterial Distance to nearest: ll _____.---------------- Foundation _-_________ Property Line --_.___--.__-__...._.-_ SEEPAGE PIT [ ] Depth -_-___-__.________ meter _________________ Number _-____--_-__-_-__ _______ Rock Filled Yes ❑ No Water Table Depth ---------- ----------------Rock Size ---- - •------------------- Distance to nearest: ----------------------------------------Foundation - Prop. Line -.-.____.--_-._------ REPAIR/ADDITION(Prev. Sanitation Permit# ___----------------------------------------- Date _____---______ -V_-.________--....) Septic Tank (Specify Requirements) ----- -_- -_ _ _< ---------------------------`i1' t_' -- -- Disposal Field (Specify Requirements) __,__:__ ------/c,/'- _ r-------RSL_A-C�---------Gif_�T_h_f�C_4�V1- �y�TI=� Q1V_L- !- - - - (Draw existing and required-addition--------on-----rev-- ---erse�i---- de - -- ----------------------------------------------•-------------- red ad ) 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: T "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." _ 4 1--7 ---c--ti Signed /-- f� /"- �- - -- �'-- __- ---- ---------- Owner �c ---- -- ---------- BY ------ A_ :.__ Title t ----- -------- - --- -- -------- -------- -------- ----------------- (ItotFSerthan owner) _ FOR DEPARTMENT USE ONLY 7 APPLICATION ACCEPTED BY -------- c ------------------------------------------------------------------. DATE ------ �/1------ BUILDING PERMIT ISSUED -------------- -- ----------------------- -------DATE --------- ----------------------------_--- ADDITIONALCOMMENTS -------------------------------------------------------------------------------------------- --------------------------------------=--------------------------- -----------------------------------------------------------------------------------------------------------------------__--_------------------------------- ---------------------------- ----------- ` -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Final Inspection by: ----------------- -------Date ----------------- ------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT ,,. E. H. 9 1-'68 Rev...5M r