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EOR OFFICE USE: ..................................:.................- APPLICATION FOR SANITATION PERMIT - (Complete in Triplicate), - �.. . . Permit No. 'S-� 97 A Date Issued ..... ..:. . ..... .............�.__..... This Permit Expires I Year From DotoIssued 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: / f� a JOB ADDRESS/L ATIQ } ' .C�_G:1_ 1. ( :.: :... .-CENSus TRAcr ...................... Owner's Name .......671/ .........Of Z5:_r. �lr-T�n Phone .................................... r r /� . . Address ._. - fi r_ .(- 1FG.._.Llil._4dl YKS..I,.... .... . .. ...D �Q�"1===--••--... ................... .city .�'.�` �F(. Contractor's Name L�.:. �t'� ......................license # Phone _ Installation will.serve: Residence❑Apartment House❑ Commercial oTrailer Court 0 ! 3 Motel ❑Other.P4Z!.. � G: Number of living units:............ Number of bedrooms -------._...Garbage Grinder ------------ Lot Size .?.......................................... Water Supply: Public System and name .............. ......................... `� •.._... ......_..................... lusts Character of soil to a depth of 3 feet: Sand El Silt© Clay ,Peat❑—Sdndy Wan 'Clay Loam❑ Hardpan d Adobe flFlll Matefia! ---._.......If yes,type. ..'.....:.. ............ (Plot plan; showing size of lot, location of ay-tibm•in•relation-tar Wells, buildings, -etc. must be placed on reverse side.) 0_1j NEW INSTALLATION: (No septic tank or seep ge pit permitted ifpublic sgwer is avail`oble within 200 feet,) / 1 PACKAGE TREATMENT [ ] SEPTIC TANK "`r,s f� S; ...................... Liquid Depth .................., ... Oil 1 vi q � V � Capacity _ ... o�jy . Material_44�7j6t 4& No. gompartments .. ...... F Distance to nearest: Well - 1_ __-Q....................Fo'undation -.77'0......... Prop. Line.ejr� LEACHING LINE [ No. of Line- .:.............. Length o I " line...... ...:_....,..... Total Len tli .. �....�.......... M D' Box Type Filter Material ... p ' '� --.......... Yp �.............De t.�F�Iter rMaterial ---. .-.................LI.........r_..... 44 . - Distance to nearest: Well ... .......... Foundation .-Z `:...---..... Property line ..,C. 90........... SEEPAGE PIT [ ! Depth .................... Diameter ................ Number ----------._ ....... Rock Filled. Yes ❑ No 0 Water Table Depth Rock Size - ' Distance to nearest: Well .. ........................Foundation .......... ......... Prop. Line ...................... ' REPAIR/ADDITION(Prey. Sanitation Permit# -_11.....1_-....................:........ Date ...:.............................. ) i Septic Tank (Specify Requirements). _ d -•--------- --- --- ----- ---- ----• ------ • ------- �U Disposal Field {Specify Requirements) __________________________ ----___�;_-___:._•-----..-___-- . ------------------------------------ ._......__._.______ ---------------------------------------------------- -- ........ _ __..._......___._....___._ .............-______-__--_-...... I ...................................... .. ..___......... (Draw existing and required addition on reverse side) . s I -hereby certify that I have prepared this application and that the work will be done In accordance with San Joaquin County Ordinances, State taws, and Rules and Regulations of the San Joaquin Local Health:District. Hone owner or licen• sed agents signature certifies the following: "I certify that in the performance of the work for which this permit Is issued, ! shall not employ any person In such manner - as to become subject to Workman's Compensation laws of California." Signed ---._-:._ ._..._ •-----•------------------- ------- Owner By ----------------------------- Title -....-- - 1_ i[ GOf�..._.. a#her than own • ` i EOR PEPARTMENT.USE ONLY q,r APPLICATION ACCEPTED BY ----- G -- DATE --_.__---- BUILDING PERMIT ISSUED .--- .....-•--•.....- - _ ..._... • ---DATE ---------- ---- ------- ---------- ADDITIONAL .COMMENTS ............................... •------•---...-----•..--•--.....--._...--•---.---...._..-•--------.....__._..:..---•--............----•-. •--------------- --- .... -------•----•••----•----- ._• ._.-.-._....----.. -• . --------•-•.----_... .---._ --•--•---.........•--..... i .......... ... •---•-----•--•------------------- ---- -----•--- ------. ... __.._ - ------ -- --- ------------------------------------------------------r) Final Inspection by: ... . . . ... ---•------------- ------- -•-•---------------•--•--------Date ... /.2 ..-�_J_73-.... --. EH 13 2h 1-68 Rev•_5K_ SAN JO QUIN LOCAL HEALTH DISTRICT 8/7)I 3H