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F FOR OFFICE USE: - APPLICATION FOR SANITATION PERMIT ----- -- Permit No. eI ------ (Complete in Triplicate) --i �I Date Issued 1,77, 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 -- - ---------1��-�-IV-W I--------------:----CENSUS TRACT S_�_��..'...... Owner's Na/me --- -.Q�-�-'--------- - - j � - - - �-/--�-- ------- ----- - - -- .. -----------Phone Address < 9 y ��- K3 lZen �Gf-- -- -- City . ` `�lOY Contractor's Name ______ �1 ------- _�_�7 /-{� License #- ' T 1_ Phone i7� . Installation will serve: Residence ❑Apartment House❑ Commercial ❑Trailer Court ❑ y Motel ❑Other ------ -�t�CL ---- f3 � y�,. Number of living units:______-___ Number of bedrooms ____________Garbage Grinder ------------ Lot Size fy<---------------- Water Supply: Public System and name --------------------------------•------------------------------------------------------------•------•---------Private :Character of soil to a depth of 3 feet: � Sand'❑:: W Silt❑ Clay ❑ Peat❑ Sandy Loam ❑. Clay-Loam:❑ Hardpan-.E] 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 seeps pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT / �-X.!.X'5��- - ��-______ [ SEPTIC TANK [ Size___.-_ Liquid Depth ___ ________ r Capacity --��0-- --- Type -?eea S 0terial.&1_VCf-d21*0. Compartments 2_.__-_/._._:__.. �W istdnce to nearest: Well ---_ ( Foundation ___�_______ ___- Pro Line ____s`�-____________ P• Total Length ----�� -____-- LEACHING LINE No:`of Lines ____/----------------- Length �each line---_-. -___ Q -- ---------- ' :D'. Box --__ �_� Type Filter Material -_-QC%__ _____Depth Fitter Material ._�f�_ ___________________ ___________ -- ,Distance to nearest. Well --�---.--__--__ Foundation 14---------------- Property Line C5_---•_______________ SEEPAGE PIT [ ] Depth --------------------- Diameter ---------------- Number ---------------------------- Rock Filled Yes ❑ No Water Table Depth ------------------------------------------------Rock Size -------------------------------- Distance to nearest: Well .---------------------------------------Foundation --------------------- Prop. Line .- •.----.._..--.--.. REPAIR,/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date ---.--..------._._.._..._..-.-----) SepticTank (Specify Requirements) -------------------------------------------------------------------------- ------------------:------------------•------------------ ...... Disposal Field (Specify Requirements) -------F9 . - nQ_�___-_/Lv-______ 1�-.Il �i_( _ r AR '----------------------------------------------------------------------------------------------------------------------------------------- ----- ------------------------------- (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 ------- -- _ `--- Owner - - ------ - ---------------------- --- By ---------- l°/� Title --.--------- ----------------------- ---•- i (If other th n owner] FOR .DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--- R- ----------------------------------------------------------------- --------- ---- DATE ------!V-7 7 '2p--------- BUILDING PERMIT ISSUED _._ .p - ----------;--------------DATE -------------------------------------- ADDITIONAL COMMENTS = tAll1S 1. 11L:�� l!`+ --------------------------------------- -- --- ---------------- ------ - -- ----------------------------------------------------------------------------------------------------------------- ---------------------------------- ------------------------------------------------------•- ---------------------------------- - - ----- ----- --- --------------------------------------------------- - -:--- ---- } --------- Final Inspec ' ------------------------------------------ -.Date ----- ! ' SAN JOA'QUIN LOCAL HEALTH DISTRICT E. H. 9 1-'b8 Rev. 5M