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t FORtOFFICE USE: APPLICATION FOR SANITATION PERMIT ------------------------------- (Complete in Triplicate) Permit No. - ------_il� - V 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 .•�/-- ---CENSUS TRACT -------------- -------- Owner's;Name ------j"- -1;�.�`-- P�i>G a,&,�/' �` -----------------Phone _59W.z=��6�3'_��_- Address,. 0-4 -.1....-� s1 [.-SCG � ------------ -•--. City J - [': --------------------------------------- Contractor's Name ---4 ,Fc _- -, __-------.License # S"yef_,7,. __ Phone' 0- '` Installation will serve: Residence ❑Apartment House❑ Commercial ❑Trailer Court ;❑ Motel ❑Other _Dccgp:2.,e_t�_________________ .. Number of living units:-077----- Number of b rooms 2------..Garbage Grinder _________ Lot Size _- ----___--__- Water Supply: Public System and name ------� A---- -cax -C.!__&-----------------------------------------------------------Private ❑ Character of soil to a depth of 3 feet: Sand'❑ ilt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ Hardpan ❑ Adobe X 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,) PACKKAGk TREATMENT [,] SEPTIC TANK,[ ] Size__________________________________.______-____ Liquid Depth __.____________..._-_-__- (,5 f,,'�-- Capacity ------------------- Type -------------------- Material------------- ----.--- No. Compartments ...................... JI� Distance to nearest: Well ___________________________________Foundation ---------------------- Prop. Line ...................... LEACHING LINENo. of Lines `. ._____ Total Len __.. q., [ ] -____�------_-__-_ Length of each line---�d---____-- Length ;� --------------- V re ( 'D' Box _6A1_ Type Filter Material __ 'SF___________Depth Filter Material __�C ----------_------------_ f--------- Distance to nearest: Well ___ t*e ....... Foundation ---/V------------- Property Line ___-_------.-.--_ SEEPAGE PIT [ j Depth . --------- Diameter ---ore - Number _____ ________________ Rock Filled Yes No 0 Water Table Depth ----4&;oRock Size __ : _ i-X-K_- �< Distance to nearest: Well __________________________________ _____Foundation -------------------- Prop. Line ---------------------- REPAIR/ADDITION(Prev. Sanitation Permit# ____________________________________________ Date ----------------------------------) SepticTank (Specify Requirements) -------- ---------- -------------------------------------------------------------- -------------- - --- --------------------------------- Disposal Field (Specify Requirements) ___ -----vGQf - - _--�c<+-.--e---------------------------------- /'„ y , ice. - ----- " -------------------------------------------- ------------ (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 t ormance of the work for which this permit is issued, 1 shall not employ any person in such manner as to become sub' o an's §orppensation laws of California." Signed------- ---- - ------ ------ ----- - - - - ------------------ Owner By -------- ----------------------- --- - -------;7--- - ---=--- -------Title --------------------------------------------- ------------------------- (If other t an owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTEDBYE G✓f`t --------------•---------------------------------------. DATE �l 1'-------- BUILDINGPERMIT ISSUED -------------------------------- ------------------------------------------------------------------------DATE ------------- ----------------------------- ADIT IONALCOMMENTS -------------------------------------------------------------- --------------------------------------------- --------------------------- --- --f'i`-- Z------------- /-J- ------ - -- ----�----- - ------ - -- (/[[--------------------------------- ------------ 1 --- ---- -- -- ----- ---------------------------------------------------------------------------------------------------- ----- -----------•- /� Final Inspection by: -------- -------------------------------------------- ------------------------•----Date h/=�i�� _---•---- N JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M