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FOR OFFICE USE: tPPLICATLON--fGR SANITATION PERMIT �, � 7 � ]' -: A �a Permit No. -- `--------- t - ---�:3�_'----------------- (Complete in Triplicate) - t Date Issued -. -6� 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/LOCATION __40AlYk-Lp__,_O -_!9-j167 Y____A- V.P-----y�}/?ef/--2 ,--_CENSUS TRACT -------------------------- Owner's -._-_--____-__-_--_ .Owner's Name .' '/�- �t ,-----> 191NA1?--------------------------------------------------------------------..._Phone 46W__©3$ 7 Address ------ -------------------------- --. City ------ ------------------------ ------------------------------------------- Contractor's Name ------- VC �.F �!l�L-__-------:--------License # -___ Phone !WAW"_7_,_��- Installation will serve: Residence V�Apartment House❑ Commercial ❑Trailer Court ;❑ Motel ❑ Other ----------------------------- Number of living units:-----/---- Number of bedrooms __o2----Garbage Grinder _ v_ Lot Size -_------_______------------------- Water Supply: Public System and name --------------------------------------------------------------- ------------------------------------------Private [ --' Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Gay ❑ 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 permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK[ ] Size----------------------------------- ---------.__ Liquid Depth ___-_-________-- Capacity ------------------- Type -------------------- Material--------------------- No. Compartments ----------------...... Distance to nearest: Well __________________________________Foundation ---------------------- Prop. Line ...................... LEACHING LINE [ ] No. of Lines _____________________ Length of each line________________________ Total Length -------------------------- 'D' Box ------------ Type Filter Material -__________________Depth Filter Material -------------------- ....................... Distance to--nearest: Well -____________________ Foundation ------------------------ Property Line ------------........... SEEPAGE PIT [ ] Depth ------ ---- ____. Diameter ---------------- Number .--------------------------- Rock Filled Yes '❑ No IQ Water Table Depth ------------------------------------------------Rock Size --- ------------- Distance to nearest: Well _______________________________________Foundation -------------------- Prop. Line ...................... REPAIR/ADDITION(Prev. Sanitation Permit# ------ Date __________________________________) SepticTank (Specify Requirements) -------- -----------------------------------------------------------------------------------------------------«.--------------------------- Disposal Field (Specify Requirements) ----"__-_ _Q__� ----------------------------------------------------------------------------------------------------------------------------------------------------------------- ------------------------- --------------------------------------------- (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 besubject o W rkman's Compensation laws of California." Signedcom ..--------------------------------------- --------------------- Owner By ----------------------------------- --------------------------- ---------------------------- Title ---------------------- ------------------------ ----------------------- (If other than owner) FO&DEPARTMENT USE ONLY APPLICATION ACCEPTED BY .------- - ------------------------------------------------------- -------- DATE _ _-. ------- BUILDINGPERMIT ISSUED ---------------------------------------------------------------.---------------------------------------DATE ------------------- `-•-----------------•- ADDITIONAL COMMENTS --- ------- -- - - - ------- ------------------------ -- - ---------- Final Inspection by: --------------- ------- - ----------------------------------------------- -------Date --- ----2 --- ------•------ SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M