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FOR OFFICE US#..''' APPLICATION FOR SANITATION PERMIT �Permit No: / --------------------------------------------------------- -- --- (Complete in Triplicate) ------------------ ( Date Issued __ _ 3=, .o� __ 1-0----__.._ This Permit Expires 1 Year From Date Issued Application Whereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This-application is made lin compliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATIOnN n.._._ -S_L__�2��,----�.�---______,J�_V_C�._�._!:�________�D---_----------------CENSUS TRACT ____-�__!_--_ ..__. Owner's Name 1 j-11_ f .0.o:R.Q�-------------------------------- - -------------------Phone ------------------------------------ Address ---------------25-1_ --------J---------/-�-o�`�-�1-�- -----r City f l m Contractor's Name ---- ----------------------------------------------------------License# ---------.-------------- Phone .............................. Installation will serve: Residence gApartment House❑ Commercial ❑Trailer Court i❑ Motel ❑Other ---------------------------------=---------- Number of living units:--- ----_ � - Number of bedrooms ---/----__Garbage Grinder _ ?--__ Lot Size _____ QfiCA6 ----------- Water Supply: Public System and name --------------------- --------------- ------------------------------------------------------------------------Private Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay E] Peat E3- Sandy Loam -e Clay Loam ❑ Hardpan ❑ Adobe'Q Fill Material _/.10- If yes,type ---------------------------- (Plot _________________________(Plot plan, showing size of lot, location of system in relations to wells buildings, etc. must be placed on reverse side. NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is avail le within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK,[ ] Size_;______________________________s'.___...-` Liquid Depth -------------------------- Capacity -------------------- Type -------------------- Material---------- --------L_ No. Compartments ...................... Distance to nearest: Well ____________________________________Fo dation ---------------------- Prop. Line ...................... %IN LEACHING LINE [ ] No. of Lines ------------------------ Length of each I- ---------------------------- Total Length -----------.,__---.._.---.__ 'D' Box ------------ Type filter Material ________ ___________Depth Filter Material _______---..--____._______--_--.__...•-_._ Distance to nearest: Well ------------------ ____ Fayndation ------------------------ Property Line ........................ SEEPAGE PIT Depth ____________________ Diameter _ -------------- Number ------------- -------------- Rock Filled Yes Q No Q Water Table Depth ---------- ------------------------------------Rock Size -------------------------------- Distance to nearest: I ----------------------------------------Foundatio.n -------------------- Prop. Line ...................... REPAIR/ADDITION(Prev. Sanitation PerVrK# ____________________________________________ Date ------------------------.:--------l c Septic Tank (Specify Requirements-) -------------y>_l_.;57't�---9-0—K-------- - �._.- ��------�d------Ml14-------- � t( Disposal Field (Specify Requirements) _ _(�C� -------WFL ,--_______._ 1 -____._-_QJ -..-___. �?__._____ �_ -______________ ------4FQC1_4----L-jtUT;=----------------------------------------------------------------------------------------------------- ---------------------------------------------------- --------------------- ----------- ------ - ------ --- ----------------------------------•---------------------------------------- ----------- (Draw existing and required addition on reverse side) 1 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 t in the performa of the work for which this permit is issued, I shall not employ-any person in such manner as to beco subject to V1�brk n's Co ensation laws of California." Signed `-1(.... ------ --------------------- Owner By ----------------------------------------------------------------------------------------- Title --------------------- ---------- ------------------------ -------------- (If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----- --t-i - -------------------------------------------------------------------------. DATE --------q.-- BUILDING -BUILDING PERMIT ISSUED ------------------------ ------------------------------------------ --------------------------------------DATE ------------------------------------------- ADDITIONALCOMMENTS ----------- -------------------------- ------------------- ---------------------------------------------------------------------=-------- ------------------ = y ------------------------------------------------------------------------------------- = -- ----- - - - -- ----- - Final Ins ection 7 z_ p _ �G�`4`/� - -Date _ � . SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M