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{ FOR OFFICE USE: = y APPLICATION FOR SANITATION PERMIT ----------- - --------------------------- Permit No. ._7�-,337 (Complete in Triplicate) --------- ---------------------------------- Date Issued --------------------------------------------------------- This Permit Expires i 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 ../-V/77.-Z-,.-J(-W/ 0 DDRESS/LOCATION ../V/77._Z,,Jury-L.0 ------- ------•-------- ---- -CENSUS TRACT -------------------------- ' Owner's Name/3'`Q1.�11f_�� l�Ql' _ �r � r7.��E17 y1 --Phone ,,.s ": —_-._._ Address ---------------------------------------------------- city ----------------------------------=------•-- Contractor's Name ---------------------•--=-- ------- --------- -----------=-------.License # ------------------------ Phone ------------------------------ Installation will serve: Residence ❑ Apartment House❑ Commercial :❑Trailer Court l❑ Motel ❑ Other Number of living units ---- Number of bedrooms _____Garbage Grinder _y_7�!S'- Lot Size __��~/ r . '_________________ Water Supply: Public System and name ----------------------------------------- ----------------------------•-------------------•-------------------Private Character of soil to a depth of 3 feet: Sandi& Silt❑ Clay E] Peat E] Sandy Loam ElClay Loam ❑ 4 Hardpan E] Adobe-0 Fill Material ____________ If yes,type _________________--_--____ t {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 TREATMENT [ I SEPTIC TANK�NA Size___�a [.tU_______19�-------------- Liquid Depth ___lam._------------- Y*11Capacity I100,9A_/___ Type ____________________ Material_4a&_eX%pt-�__ No. Compartments ------ ._.__-:---_ = Distance to nearest: Well ------------------------------------Foundation ---------------------- Prop. Line ---.--------.--------- r LEACHING LINE [ ] No. of Lines __-- --------------- Length of each Zine ---------- Total Length --- 'D' Box __ --------- Type Filter Material ____________________Depth Filter Material --------..----------.______----______-....__ - t Distance!to nearest: Well __%_7!1_____-__---- Foundation _. ------------- Property Line _I.�5___...... ._ SEEPAGE PIT [ ] Depth ,_ _ --------------- Diameter ---------------- Number _____._.-------__________- Rock Filled Yes E] No Ii WaterTable Depth ----------------------------------- ---=--------Rock Size -------------------------------- Distance to nearest: Well ----------------------------------------Foundation -------------------- Prop. Line ....___.._ .......... k REPAIR/ADDITION(Prev. Sanitation Permit# ________-------------------- --------------- Date _____-_-____.________--.----------] SepticTank (Specify Requirements) ---- --- -------------------------------------------------------------------------------- --------------------------------------------------- Disposal -------------------- •--------=---- Disposal Field (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 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 bject toWorkman's Com,pensation laws of California." ' Signed .__ ------- Lr Owner BY ------------ � � ` Title ------------------------------------- 5 f other than owner) ' FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ---- DATE y �3 -I------------•------- s BUILDING PERMIT ISSUED ---------------------------------- ---------------------- -------DATE ------------------------------------------- ADDITIONALCOMMENTS --------------------------------------------------------------------------------------- ---- ------------------------ -------------=---------------•----------- a ' ..----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- -t� t I - --- --- ---- ----------------------------------- ----------------- ------------------------------------------------- ----------- ----------- -------------.------------------- ------------------------------------------------------------------- ------ Inspection b Final Ins p Y: -------------- - --------------------------------------------- .Date -- SAN JOAQUIN LOCAL HEALTH DISTRICT Cf t E. H. 9 1-'68 Rev. 5M