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FOR OFFICE USE: I APPLICATION FOR SANITATION PERMIT ;`_ - Permit No: _-7/-/ 0-7/- i. (Complete in Triplicate) ------------------ -------- - ----- 1__ 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 m e in compliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION _Il.--- ---- Y1 / --------- .-----------------CENSUS TRACT -------------- ........... Owner's Name ------------- -- - -- - ------ ----- -- -------------------Phone ----- Address IIT--------- city Contractor's Name --------------- �,. -------!___ ;---- ------.License #AW.X,1/------ Phone ----- Installation will serve: Residence)(Apartment House❑ Commercial:❑Trailer Court i❑ Motel ❑ Other --------------- ,, Number of living units:------:�i____ Number of bedrooms ____________Garbage Grinder ------------ !ot Size -------- ------ WaterSupply: Public System and name --------------------------------------------------------------------- ------------'---------------------------Private Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat❑ Sandy Loam`d Clay Loam ❑ II Hardpan ❑ Adobe-El Fill Material ____________ if yes, type __________________________ �F. (Plot plan, showing size of hot, location of system in relation to wells, buildings, etc. mustbe 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----- _.?X___ ------------------------ q p , Capacity 04�_(71 4- Type _&4-------- Material__(Z' 14------ No. Cori partments -_----.._...___.. 5'A, Distance to nearest: Well _-_____ __f________________Foundation _._.l0---I--------_„Prop. Line '....... LEACHING LINE No. 'of Lines --------07 Length of each line--------FrQ --------- Total Length _____� ._ -__ •i 1 'D' Box Type Filter Maternal _)__ _ _ ____Depth FilterMaterial -----/_-<?________________--_______.____._ Distance to nearest: Well __ _�______________ Foundation ____/0__4-______ Property Line. ..... SEEPAGE PIT [ J Dept h -------------------- ________________ Number _________.________.______ Rock Filled Yes C] No 0�E , Water Table Depth ------------------------------------------------Rock Size -------------------------------- Distonce to nearest: Well ---------- ________________Foundation -------------------- Pr,P- Lin e;,,-___....__..___..-_ .. h REPAIR/ADDITION(Prev. Sanitation Permit# ------------------ --.---�''------------- Date -------------_----_-------- Septic ---_--.----sSeptic Tank (Specify Requirements) ---------------------'�--------------------------------------------------------- --------------------------- '---`---------------- r , .� - r Disposal Field (Specify Requirements) _________�`-' ------------`--- = ------ ----- -1-- -- - ----- - - 4 , ------------------_______ _____ ________________________________ ___ --------------------------------------:-------------- --._ _____ _ _ •S (Draw existing and_requiFFed°additioyn'on_revers_e side) 1 hereby certify that 1;havenpreparecl this application and-that the work will be done in ccordance with San Joaquin County 10rdinances, State Laws, and Rules and Regulafi`ons of the San Joaquin Local-Hedlth,District:.Flome 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`6 y person in such manner as to become subject to Workman's Compensation laws of California." - -- M Signed �--- Owner i� Al �_Ot than o�By --------- Title - '-------- `' ------------- i at -.;;--------- Iwner) ;p FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY', ___ ----------------------------------------------- DATE!--.------ --f, ?/"`--------------- BUItD`ING`PERIVIIT—ISSUED - _.�- -_._- = =-_- = � --------DATE--------------Y----------- ------._-. ADDITIONAL COMMENTS ___!!1____________._ __ ----------------------------------------------- -------------------------------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------ = C --- - ------ ----- - --- - 3 --- -------------------- �Final Inspection by: r. --------------------------------------------- Rate SAN JOAQUIN LOCAL HEALTH DISTRICT E. H.-9 • 1-'68 Rev, 5M IM