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FOR OFFICE USE:�. - r• APPLICATION FOR SANITATION PERMIT - (Complete in Triplicate) Permit No: --------------------- ---- � 9 - ------ - - - - - 4 A - Date Issued -------------.-_.__ 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: t [>0;Q JOB ADDRESS/LOCATION. J �O 'J Std, f j� !o,vty" -------- ---- ------- r -- -----------: - - - - - - .: -- � --- --- TRACT Owner's Name -------_/4_r/V_x_y - -------------- --~° _ _ `/ Phone- ------ ------- ' Address . ''� ----------�5-0-�---- f?-�'a-luv�' l�/ i� - -- -��I?_�'_�v-- -----�--- �U/y--------` ��---:.-City -_--�-- - - -�---- �M-------- -------•-----------------•-------- _ ---- -Contractor's Name -----F----- "" --- _-- -------r:Ucense # -- 6. - Phone - � 3_-y2r Installation will serve: Residence Apartment House❑ Commercial'❑Trailer Court ;❑ a Motel ❑Other -----8C'ly-_at-`_ Number of living units:------I_-__ Number of bedrooms ___Aq-----Garbo'e Grinder -_ __ 9 IYC� - Lot Size ---��----�� S' �5------- Water Supply: Public System and name --__________________ Private --------- --------------------------: of soil to a depth of 3 feet: Sand'A Silt❑ Clay ❑ Peat❑ Sandy Loam ,F] Clay Loam :❑ Hardpan ❑ -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.) IN NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) i PACKAGE TREATMENT [ ] SEPTIC TANK'[ ] Size-----------•------------------------------------- Liquid Depth -------------------------- i -----------_---------- -s Capacity-------------------- Type--- ---------------- Material--------------------- No. Compartments -----------------:--- V , ' Distance to` nearest: Well `-- --------------------------------Foundation -----------_-----------Prop. Line -----_------------_--- LEACHING LINE [ ] No. of Lines ________________________ ength of each line---------------------------- T tal Length D' Sox -____.____- Type Filter' aterial ____________________Depth Filter Material __-___-___-- ... ' Distance to nearest: Well ----- ------------------ Foundation ------------------------ Property Line ------------------------ SEEPAGE PIT f ] Depth ________-_ i __--__ Diameter -_-_.__________ Number ____________________________ Rock Filled Yes ❑ No i❑ Water Table Depth ------------ - --------------------------- ----Rock Size -------------------------------- i r Distance to nearest: Well -___-_ _ ______:__.__AFoundation ___________________ Prop. Line r ` _______--_..__._._. REPAIR/ADDITiON(Prev..(Prev. Sanitation.Permit.#.------- - -------------------------------- Date ---------------------------------- GA ---------------------------- .. �� Septic Tank (Specify Requirements) ------------)_� a3-----,_- - -- Dis osal Field (Specify Requirements) _--------_ = _S_ 1"7 ------------------- ---- ----- -------- ---- - -- --- ----------- -- - - ----- -- ------= t i 4* {Draw existing andFrequired-�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! "I certify that in the performance of,the-work-forrwhich'fhis permit is issued, 1 shall not employ any person in such manner as to become subject to Workman's Compensation laws of California." Signed '_ f _ _ rS0 - : Owner --- -- BY ------- - ------ = --------------------------- ----- Title (if other than er ..} FOR .DEPARTMENT USE ONLY APPLICATION ACCEPTED BY { Er �— - -- -----•--- - DATE BUILDING PERMIT ISSUED --------- ---------------------DATE D1TlONAL COMMENTS �_______ " ------------- -- - ------- ------------------------------ ------------------------- - ---------------------------- ---------- - ---------------------••------------------ -------- - -- --------- ------ -------- -- ---- ----- ------- ---- - ---- - ---- -- --- - Final Inspection by: - ��v - t ' Date __.._e-a4_ _- _ ' SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9�, 1-'68 Rev. 5M. R