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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT --------------------------------------------------- 7 -f \\ (Complete in Triplicate)Ir- Permit No_ _____________________ ---------=--------------- ------------------------------- -------------------_---------------------__-------------- This Permit Expires 1 Year From Date Issued Date Issued 2'�--..7.0 Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This application ismadein compliance with County Ordinance No.X5/49 and existing Rules and Regulations: JOB ADDRESS/LOCATION .__ID.��.3---- -----A _E__L 8_E- --T-- -- ---- --V__. -_._-------.CENSUS TRACT ------ ----------------- Owner's Name J-R.�- C-J-------J,------�f� �(��_�._�1.��5.--------------------------------------------Phone —A4Z 156.1.---- Address -7--Z-0--7-----E------- - - 1�_ --t--}---------AJZ- ...... City ------------------------•------ Contractor's Name -- ---------------- License ----- Phone -------------------------- -- Installation will serve: Residence 0� Apartment House❑ Commercial ❑Trailer Court ❑ Motel ❑Other -------------------------------------------- n -------------------- ----------------- pp 11 U Number of living units:---- Number of bedrooms ___ ______�G�arb ge Grinder lY_�_, Lot Size ��+__0 -_ G_�_ . Water Supply: Public System and name _C_1_7�; ____-._ _- !!':_.5,�________-------------.__.__•------------------------------ __-_Private ❑ Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ;❑ Hardpan ❑ Adobe D, Fill Material ktfi./=jf yes,type _________________________- (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 [ ] SEPTIC TANK:[ ] Size_______________________________________,___ Liquid Depth ________^_____-_____-_-- Capacity _ �_�_0_Q__ Type TMaterialCPff4 I'E_TENo. Compartments ______ ........ Distance to nearest: Well --------------______________-------Foundation ._<_d_-__________ Prop. Line _..__ _.._._.__.__r/ S • t LEACHING LINE [ ] No. of Lines -____ _____________ Length of each line______________________ Total Length __L_7o_. /� t 'D' Box ---- Type Filter Material-W! -4epth Filter Material ---1_?----- ......... Distance to nearist: Well ---------- -------- Foundation -------/Q_-_------ Property Line ------ ................ SEEPAGE PIT [ ] Depth ---- ,S. ------- Diameter ___3_ ______ Number -----------4------------- Rock Filled Yes No ,l❑ Water Table Depth -----6s-- ----------------------------------Rock Size -------------------------••----- 17 Distance to nearest: Well ________________________________________Foundation -------/_Q------ Prop. Line ..__. .......... (tea REPAIR/ADDITION(Prev. Sanitation Permit# ____________________________________________ Date ----------------------------------) 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 County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner or licpn' 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 beco a subject to W rkma 's Compensation laws-lof California." Signed -------------- Owner ---------- --- BY Title �/— --------------------------------- (I they than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY --- -- Y -- ------------------------------------------------------------------------------------. DATE ------ �� ----------------------- BUILDING PERMIT ISSUED ------ ---------------------------- -----------------DATE ------------------- ----------------- ----------------------------------------------- - -- ADDITIONAL COMMENTS ----------------- -------------------------- ----------------------- --------------------------------------------------------------- --------------------------------------------------------------------------------------- -----=------------------------------------- --------------------- -------- -- ----------------------------- -- ------- ---- --------------------------- ------- ------------------- --- ----- ------ ---- ----------------------------------------------------------------------------------- --- - -- - - -- Final Inspection by: - ---------------------Date ------------ -E ------=------ SAN JOAQUIN LOCAL HEALTH DISTRICT E. H/9 1-'68 Rev. 5M