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FOR OFFICE USE: t ' Zti APPLICATION FOR SANITATION PERMIT � 171 (Complete in Triplicate) Permit No: __________....____. ---------------------------------------------------------- This Permit Expires 1 Year From Date Issued Date Issued-�/G�-��c Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein escn ed. This ��pplicate n is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: If - 4-/ ;��a4 .bb 1, Arwe JOB ADDRESS/1-OC J✓�tIG CATIN .-----------�- S( Q__ - il�'Q ]A-------- ACT ------- 1 r p 7 t��/-------------------- ----------�--------- ------ Phone Owner's Name o -------------------_-- Address Address _ J � ------`5�---__/C! tt -------- -. City _ f€C+I ---------- ------------ Contractor's Name ------ ._,(_".__,_„ G _ --__---_____-_._______.License # A_/--�9�----__-- Phone _,p Installation will serve: Residence Apartment House❑ Commercial:❑Trailer Court i❑ Motel ❑Other---------------------- -------------------- wz— Number of living units:----------- Number of bedrooms . '"_.Garbage Grinder ------------ Lot Size _AC_RE/4_k_-- Supply: Public System and name ----------------------------------------------------------------- --------------------- ---------------------Private a Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat❑ Sandy Loam Clay Loam;❑ Hardpan ❑ Adobe ❑ Fill Material 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 TREATMENT [ ] SEPTIC TANK [ ] Size------------------------------------------------ Liquid Depth ___--_-_-__-------_____- CapacitY ------------------- Type -------------------- Material-------------------- No. Compartments ...................... Distance to nearest: Well _------_---------_-_-_-__ --____-Foundation _-_ ----------------- Prop. Line ______________________ LEACHING LINE [ ] No. of Lines -_ ---------- Length of each line---------------------------- Total Length ---------------------_---- 'D' -_-__.-___-,__.---_- --_'D' Box ------------ Type Filter Material --------------------Depth Filter Material ---------- -----------.-__--_-.-_____.------ Distance to nearest: Well ------------------------ Foundation .-.----.---------------- Property Line _-_____-______.___- SEEPAGE PIT Depth -------------------- Diameter ---------------- Number ------.--------------------. Rock Filled Yes ❑ No i❑ Water Table Depth --------------------------------------- --------Rock Size -------------------------------- Distance to nearest: Well ---------------------------------- ---Foundation -------------------- Prop. Line ...................... REPAIR/ADDITION(Prev. Sanitation Permit# ____________________________________________ Date _-_____-�_yn-___________:___--.-._-__)) - .� Septic Tank (Specify Requirements) --------------4d ---- �!'�L�,z`-------�V 7f__-----J__,eul------. ---------- Disposal Field (Specify Requirements) -----------+-'_________________ ------------------------------------- it --------p1sT-----13.O?C---- -----2LL------ �`�----- ---X �'�----------- SA-U�_----lNt�---a ------------------------------------------------------------------- ----------------------------------------------------------------------------------------------------------------------------- (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 subject to Workman's Compensation laws of California." Signed ---------- ----------------•,f_ Owner Y - - __ - - ------- ------------------------- Title ---------------- ------------------------------------------------------ (If other than owner) --t-- FOR DEPARTMENT USE/!ONLY APPLICATION ACCEPTED BY t _ -------- ------------------------------- - -------------------------- -----. DATE ------!;;�4_-_67------------- BUILDING PERMIT ISSUED --------------------------------------------------------------- r= - - ---DATE ADDITIONAL COMMENTS ------- ----------------- - ------ - --------------- -------------------------------------------------- --- -- - - - ----- - -- - ------ -- -------- Final Ins n by: - Final Date ------ SAN - - SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M