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FOR OFFICE USE: 70-/ APPLICATION FOR SANITATION PERMIT ------------------ 6+ -------Z41P Permit No. f�1iy�f (Complete in Triplicate) �`.3GPf'�7Jj� Date Issued _'.7(, ___-_____-______ -- --- 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/LOCA�TTIIIO,N - CENSUS TRACT - Owner's Name ----/ter -lC)-d t'� t�J`-------------------------------------------------- -------------------Phone ------ 1 , ---- 'r�--------------------------------.- y -Slz7 1�1------------------ Addressl'/'"-- G'��1.�--- - - - Cit -- ---------------------- Contractor's Name --------- .j ------------------------License # -11,E- ----- Phone Installation will serve: ResidenceA Apartment House,❑ Commercial ❑Trailer Court ;❑ Motel ❑ Other ---------------------- ------------------- Number of living units:_____._ Number of bedrooms ---e�k-----Garbage Grinder _1S/_____ Lot Size ------------------- Water ---------------_Water Supply: Public System and name ------------------------------------------ ------------------------------------------------------Private ❑ Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam El Hardpan ❑ Adobe 0 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 i❑ Water Table Depth ------------------------------------------------Rock Size -------------------------------- Distance to nearest: Well _____._.___-______-_____-__-___-_----Foundation -------- ----------- Prop. Line ______________________ REPAIR/ADDITION(Prev. Sanitation Permit# -_--_-_ ------------------------------------ Date ---------------------------------- Septic _-_____---__-_---_-____-___-__Se tic Tank (Specify Requirements) --- --1- ------.- ------------------ --------- Disposal Field (Specify Requirements) ------AW-- -_-___��'�.___.,L�/j�j�__,�/V�_.�iJCO___.,F...v_��''�.��.____ ----- -- -- ---------------------------------------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------ -------------------------------- (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/subjeto Workman's Compensation laws of California." Signed ------------------------------------------------ Owner By ------------------ -- - -- ---- ------------------------------------------------------- Title ------------------------ ------------------------------------------ h n owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ---- _ --- ------------------------------ ------------------------. DATE _,--------------------- BUILDING PERMIT ISSUED ___-__ DATE __ _____0-0 ADDITIONAL COMMENTS _l0 Z ._7_� <G ____- /Q ,��._46 ----- -- -------------------- -- - - - --------- - -7---- l '''am��r �' `�` �_-/ �/�_ Cry - ----------------------- ---- ------- ------------ FinalInspection by: ----- �---------------------------------------------------------------------------- --------------------Date --- --------------- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M ar