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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No. .� ------------------------------------------------- - (Complete in Triplicate) 99_. Thi - � 4�.s Permit Expires 1 Year From Date Issued Date Issued -----.------_----.--_ -,_-----__--------------------- Application is hereby made to the San Jbaquin 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, rrLL� a h&La `.E. JOB ADDRESS/LOCATION ._I_T ��_ :.1-Via_->�i±J��'� -- ate CENSUS TRACT ---------------___-._--_- �' Fy�xr7 r,W Owner's -- Name AYi�J,7, W--------r P"__-�P✓�-- -------------------------- _- ----- Phon �r- Address - l_ � P-1y Ifc��i- /� --------.`.. City '40 i Contractor's Name - X / � '___ '' --------.---------.License #-2 4� PhoneJU - 9 Installation will serve: :Residence [Apartment-House-❑ Commercial ❑Trailer Court [3 Motel 171 Other -------------------------------------------- -- Number of living units:---,/ Number of bedrooms---S_Garbage Grinder ./ ___ Lot Size a0_444W ------------ Water Supply: Public System and name ---------------------- ---------------------- ---- -------------------------------------------------- ---Private Character of soil to a depth of 3 feet: Sand'[Silt.0 Clay E] Peat E] Sandy Loam •E]. Clay Loam EJHardpan E) Adobe '❑ Fil[ Material __A/0---``0--- 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.) NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENTF [ ] SEPTIC TANK f ] Size---------------------------------------------------------------------- ------ Liquid Depth ---------------------.----- V` Capacity -------------------- Type -------------------- Material---------------------- No. Compartments ----------------- i 4 Distance to nearest: Well ------------------------------------Foundation ------- -------------- Prop. Line _--_---_-.---_-.-_ a LEACHING LINE [ ] No. of Lines ------------------------ Length of each line---------------------------- Total Length ---------------------------- 'D' Box. ----------- Type Filter Material._- '-,-------------Depth,'Filter Material ------------------------------- ------- Distance to nearest: Well ------------------------ Foundation __ ----------- ---- Property Line. ---_-_-_---_-_-__,._-_._ SEEPAGE PIT [ ] Depth -.------------------ Diameter ---------------- Number ---------- --- -------------- Rock Filled Yes ❑ No .0 Water Table Depth ----------------------------------------------- -Rock Size --- ---------------------------- Distance'to nearest: Well ----------------------------------------Foundation -------------- ---- Prop. Line -_------------------ REPAIR./ADDITION(Prev. Sanitation Permit# ------------------------------------ Date -----------.-----_--_._:_-----_-___) I ? Septic Tank (Specify Requirements) -------------------------------------------- -------------------------------------------------- Disposal Field (Specify Requirements) 44 T ' r ------------------------ ---------------------------------------------------------------------_---------------------------------------- ------------------------- -------- - ----------------------------------------------------------------------------------------------------------------------------- -------------i__1 (Draw existing and required addition on reverse side) iI hereby certify that I have prepared this application and that the work-will be donee in accordance with San Joaquinw- County Ordinances, State Laws,,land 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 - ' _ - ----------------------------------- Title '� ., /91y---------------- - -------- ---------- (If other than ow �-� FOR .DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ? F t.F O R - -. DATE BUILDING PERMIT ISSUED --------- ------ I---------------------- - - -------------------------------- --------------DATE - - ------------------ -- ' ADDITIONAL COMMENTS ---- --------------------- --------------- ----------------•------------"~ ,.. Ae ------------------------------------ -------- ------------------------- - -- ------- ----- - --------------- '----------- ------------------------------ ------------------ --- --- --------- -- -- --------------------- --- -- - ------------------------------------------------- ------------------- k Final Inspection ---------------------------------Date --- jl/ t SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'66 Rev. 5M