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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT �7G - t - Permit (Complete in Triplicate) 411_0------------------- 1) 8__66— 8__66 f-- '' _-_________ 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/LOC ION __l.�_ _ ,_ k.J--- - ----CENSUS _�_g _Q TRACT Owner's Name - -------------- -- - - - - ----------Phone.46;� —//43--- Address - ----------------- ----- - --- City _T��°-'- --------------------------------------------•------ -----�----�-------------------- 00 /� Contractor's Name - 4f-_ `�_______ . (,__ - ______.License #�¢-Q3-f�,1L_ PhoneC�__- Installation will serve: Residence :Apartment House❑ Commercial ❑Trailer Court // Motel ❑Other - =----------- ,,��// �^ Number of living units:-:_I______ Number of bedrooms ___ ____Garbage Grinder 4Y0---- lot Size -_�_ _1�_ .z_s1__ Water Supply: Public System and name __..___ _ -� _________Private ❑ - -- ---- - ------------------------------------------------------------ Character of soil to a depth of 3 feet: Sand'❑ SNt❑ Gay ❑ Peat❑ Sandy Loam ❑ Clay Loam 0 Hardpan ❑ AdobeoFill 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.) p NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) R4 PACKAGE TREATMENT [ I SEPTIC TANK [ ] Size-------------------------------.---------------- Liquid Depth _____-_________-____-___ Capacity ------------------- Type -------------------- Material------------ ------- No. Compartments .. --------------- (�1 Distance to nearest: Well --- --------------------------------Foundation ----------- ---------- Prop. Line ______________-_____ t LEACHING LINE ( I 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 C] Water Table Depth -----------------------------------------------Rock Size -------------------------------- Distance to nearest: Well _______________________________________Foundation -------------------- Prop. Line ____-__--___ ........ REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date ______________________-___________) Septic Tank (Specify Requirements) -------- -----------------------------------------------._ --------------------C-%--- ------------------------------------------------------- Disposal Fie (Sp cify Requir meats) ---,. --=- --�t.. ---___, ___l� �4__:-_____ iz _----------- - L7 - -5-3------------- -------- - --- - -- ------- - ------------- - --------- ------------------ ------------------------------------ ---Dr xisting and required addition on reverse sid I hereby certify that I have prepared this application and that the work will be don accordance with San Joaquin County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Hea th 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 beco to Work an's C sation laws of C [Ifornia." Signed _ __ BY ------------- - Title ---------------------- ----------------------- f other than owner) F DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ____- --- _ _ _ —- -_ _ DATE __�- ?- --•________________- B ILDING PERMIT ISSUED ____ DATE _-_________________________________-_____ - - - -------- -------- ------------------ --------------------_DATE COMMENT ______ ,r_______________ `J --------- -------`t J------r---- ------------------------------- Final - - - -------- - - ---- -------------------------------------------------------------------------------------- Final Ins ection b ^--- --- -/---------------=------ P Y -------- ------------------------------------------------------------------------Date �- ---------•------- JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M