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FOR OFFICE OSE: APPLICATION FOR SANITATION PERMIT --------------------=- - (Complete in Triplicate) Permit No. . d_�__ _.. This Permit Expires t 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 'JAZ_ __ '—r__ -11�e1`P�i7 __—.......F--SC_'_.-9/b_Y7--------------CENSUS TRACT ----- Owner's Name ------------------------:--------------- --------------------Phone s_.-?X_-7�6 47 Address 7 Z"?'� _01 r_N Ar Cit est/o -m.�- /7 /� v '� Contractor's Name ________ _. ----------------------------------- -------- #/0-04—Z!--- Phone .` '56e_7. Installation will serve: Residence O!Apartment House❑ Commercial []Trailer Court l❑ Motel ❑Other _ � /At,—R-' ----__Garb Number of living units:________ Number of bedrooms __ age Grinder -_________ Lot Size . o -_-_ Water Supply: Public System and name -----------------------------------------_-:__ __-Private J Character of soil to a depth of 3 feet: Sand❑ Silt C] Cfcy ,�---Perm-6----Sandy trni Hardpan 5C Adobe ❑ Fill Material ------------ If yes,type ---------------------------- (Plot __-___----__- -__(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_:o __�?�___ ._�________._________-_ Liquid Depth oS ....�..._. v n �t \, Capacity _42_4______�s_ Type 1'n.-_- v/_ ._. MaterialC�"�x�--- No. Compartments -.-_ t___....___.- N Distance to nearest: Well -1p-Q. _F_____:If I ''_____-__---Foundation --------prop. Line ....... LEACHING LINE No. of Lines ---1------------------- Length of each line__7s ______.___ Total Length -_--�a _____________ D' Box ------------ Type Filter Material Sy-Vsl.a_Depth Filter Material ----/0.AA.............................;+ Distance to nearest: Well -/__/_©----__-___ Foundation ._.__.l A�--------- Property Line ..... .......:z __--__- Diameter __ __b`�_._ Number __________ _ SEEPAGE PIT � Depth _,�S____ / � �______._____ Rock.Filled Yes �, No Water Table Depth __&V--------------------------------------Rock Size -'. f-A --' ' Distance to nearest: Well -_-�__ v` _______________________Foundation -------- .r___- Prop. Line ........1-0 f' REPAIR/ADDITION(Prev. Sanitation Permit# ____---------------------------------------- Date ------------------_-___-_______.__) SepticTank (Specify Requirements) -----------------------------------------------------------------------------------------------------------.._--.---------------------------- DisposalField (Specify Requirements) ------------------------------------------------------------------------------------------------------------------------------------- --------------------------------------------------------------------------------------------------------------------------------------------------------------------- ----------- ---------------------- ------------------------- ------------------ ---------------------------------------- --- ----------------------------------------------------------------------------------•------ (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: "1 certify hat in the performance of the work for which this permit is issued, I shall not employ any person in such manner as to be o e sub* t to Wo an's C pe sation laws of California." Signed . ------- t,�- - --- ------ --- ----------$ ' By --------------------------------------------------------------- ------ Title ------------------------------------------------ (If � (If other than owner) - ------------------------------------------- FOR DEPAR MENT USE LY APPLICATION ACCEPTED BY ---- Vt_R—_0------------------------------------------------------------------- -------- DATE --- ---1.9--70"------------ BUILDINGPERMIT ISSUED ----------------------------------------------------------------------------------------------------------DATE .------------------------------------------ ADDITIONALCOMMENTS ------ ---- ----------- - - ---- ------------ ---- ---------------------------------------------------------------------------------------------------- --------------------------------------- ---- ------------------ - ---- ---- - - -- -- ------------------------------------------------------------------------------ -------- -- - -------------------------------------- ---- -- -- ----- ----- --- --- -- --------------------------------------------- � Final Inspectio - -- - - ---- -- --- Date - SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M