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FOR OFFICE USE: r -7 � APPLICATION FOR SANITATION PERMIT . ------- -------------------------------------- �-. r" =i` 4GnFoIge DfTrlplicatel Permit No: ..,�j-_- ____ _____________ ate Issued r _:_ _?/- __ ____--__-_____-___ This Permit Expires 1 Year From Date Issued D 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. 349 and existing Rules and Regulations: JOB 'ADDRESS/LOCATION f1fh -__CENSUS TRACT ---- --,- ---------------- ��,—� - - -- - /./----,�Pal�D�� - - l�C�� - -------- - - - - Owner's Name 6J, �....F----- 5eljvx -i----��ff'---------------------- ------ ----------------------------- �/ -------------------Phone 7�.F'735�/---------- Address -----//J-67A,-t;?5?Z-R-------------------------------------- ----------- City _._ / rJrV---------------"-------------------------- Contractor's Name --- ------ -- ---------------------License # -`-T/-6--'K 1--- Phone Installation will serve: Residence ❑ Apartment House❑ Commercial'E]Traifer Court i❑ Motel ❑Other ------ ------------------------------------- Number of living units:_ _ Number of bedrooms -___-_______Garbage Grinder ------------ Lot Size -------------------------------------------- Water ___'______________________________________Water Supply: Public System and name -------------------------- ------------------------------------------------Private ❑ t Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat ❑ Sandy.Loam -❑ Clay Loam;❑ Hardpan ❑ Adobes 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.) N. NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available with'in'200 feet,) PACKAGE TREATMENT [ I SEPTIC TANK Size-_-,?, _______________ Liquid .-Depth _/x/__ _________________ p Capacity jR0e4 TypelMateriall7�,¢� ,� No. Compartments - _______________ —�-- Distance to nearest: Well __-_-___ _ ___ 4' - - - -__-_--Foundation ----lf�_____________ Prop. Line -__.5-. ----------- LEACHING ---____-- - - --------------- LEACHING LINT: JA No. of Lines ---------/---_-------- Length of each line__/.G` ________.______ Total Length 'D' Box .ACL___ Type Filter Material /f A --------Depth Filter Material _If��_____ „ . x Distance to nearest: Well -__—----------------- Foundation _/p_----------------- Property Line. ................ SEEPAGE PIT .j,O Depth _____ Diameter A.3-------- Number ------f------------- Rock Filled Ye& No 1 , f Water Table Depth t �U-------------------------•---4-------.Rock Size -Y - Distance to nearest: Well -------------'---------------- --------Foundation ----1U(____-- Prop. Line _.5............... E REPAIR/ADDITION(Prev. Sanitation Permit# ---_---•------------------------------------ Date ---------------------------------_) «_ r i Septic Tank (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 ¢ •. d 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 f as to become subject to Workman's Compensation laws of California." o Signed -- - - ---------- -------------------------------------------------- Owner : By ---------- -- -=----------------- Title - -------- -------------------- f ---------------------------------------- f of r an owner) ; OF 01 DEP, fiMENT USE ONLY [ (.SV- APPLICATION ACCEPTED BY 7-- t ."---------------------------------------------. DATE --- --��7 7 BUILDING PERMIT ISSUED --------'-'' __ A 'f� = DATE s - - ------------------------ ADITIONAU COMME -----1`--- I/----------------------------------------------------------------------------------------------- ------ {�s F r - -- ---�-`------------------ -------------- ----------------------------- - ------ - ------'-•.�--- -- - - _ ------ ----- ----"-----------------__------ --------- -'---�--------------------- b -- ----- / 1/_ -------- ------- Final Inspection by: ------------��---�•�� -- . -�--- ------r----��-� --------------------Date .----------- - �------ � - t------- SAN JOAQUIN ,L'OGAL HEALTH DISTRICT z E. H. 9 1-'68 Rev. 5M.