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F«R OFFICE USE: 6T. APPLICATION FOR SANITATION PERMIT ---- -------------- - --------------ti"�'�-�------------ Permit No: --�=3��-3---- iComplete in Triplicate) ---------=----------Ay� - - 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 made in compliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION �� f `_-� �j ------------------------------------------------------ CENSUS TRACT . Owner's Name li /"l Fel ---------------- Phone ------------------•-•-•---•--------- Address --- 4V:e -- ----- -- - - ---- City {�' � �= Contractor's Name ___ __ _ l _. `^ ------------------------------ ---LicenseA�- #41-2r - ------ Phone,4,/! .. Installation will serve: Residence (Apartment House❑ Commercial ❑Trailer Court ;❑ Motel ❑Other -------------------= ..,.----- Number of living units:_____ Number of bedrooms _;�4------Garbage Grinder Lot Size _ 14�_"�___________________ 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 [ I SEPTIC TANK'[ ] Size,-------- Liquid Depth ________________._...___- Capacity -------------------- Type i----------------- 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 .__-_______________._______---------------- Di�*tance to nearest: Well ______________________ Foundation ------------------------ Property Line _.-_____.______.__.-.___ SEEPAGE PIT [ ] Depth ____ --------------- Diameter ---------------- Number --------------------- -_ Rock Filled Yes ❑ No i❑ Water Table Depth ------------------------------------------------Rock Size -------------------------------- Distance to nearest: Well -__--_---_____--- _______-----Foundation _________________ Prop. Line ...................... REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date -_--____-___________...___._______) Septic Tank (Specify Requirements) ______ _ _____ ------------------ _ -- -___.---__ ---- -- ✓V, � .tea Disposal Field (Specify Requirements) ---c ' _______� ----_ _____ ___ -------------------------- --------------------------------------------------------------------------------------------------------------------------------------------------------------------- (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 become subject to Workman's Compensation laws of California." Signed ( E d Owner BY --- Title --- "' Z - ~-- -------------b Ifo than owner) Y FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY --- -. DATE ----- �--------------- BUILDINGPERMIT ISSUED ------------- ------------------------------------------------ -------DATE ------------- ---------------------------- ADDITIONALCOM NT .- --------------- ------------------------------------------------------------------------------------------ `------ *=-F-_�------------- �� -- s'qu --------------------------------- -- - ---- ---------------------------------- ---------------------------------------------------------------------� FinalInspection by. -------- -------------------------------------------------------------------------------------Date --- /--- ��^ -------------•------- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 51N ;