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FOR OFFICE USE: {~ 1 b� APPLICATION FOR SANITATION PERMITi i r ✓ - --------------------------------------------------------- � - (Complete in Triplicate) Permit No. ----- --------------------- This Permit Expires 1 Year From Date Issued Date Issued __-�-`-`---_-._-- Application is hereby made to the San Joaquin Local Health District for a per 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 . W�f -------- �--�----------------- CENSUS TRACT a�_ 32 Owner's Name !V/-3 "1 /t C Cl ca ----- - - r--------------------- ------------------ ----- - Phone ! ( 3 Al c �� ► T J"l fa r�r i Address ---- ------------ ------- -------- City -- --------------------------------------------.------------ T T h u�� ' f S� the / 6 ' -F( Phone _ +'*__ `I_Z I '� Contractor's Name ---------- -- ---------X------ ----------------•--------------- License # - Installation will serve: Residence ®Apartment House❑ Commercial ❑Trailer Court ;❑ Motel ❑ Other -------------------------------------------- /"i - 7"r S Number of living units------I------ Number of bedrooms ________Garbage Grinder ___��'-_ Lot Size ___"'______________________________________ Water Supply: Public System and name ---------------------- ----------- ----------------------------------------------------------------------------Private Character of soil to a depth of 3 feet: Sand'® Silt❑ Clay ❑ PeatSandy Loam •❑ Clay Loam ❑ Hardpan E] Adobe ❑ Fill Material ��-___ if 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 f ] ize-------------------------------------------=--- Liquid Depth __------------------------ r ` - Capacity -- ---------- ------ Type ---------- -------- Material----------------- o. Compartments -----------------•---- V Distance to nearest: Well __________ -- --------------------- ______ ___ __ Prop. Line ----------------- LEACHING LINE [ ] No'. of Lines ________________________ Leng h of each line------------.------------ __ Total Length ,_____..___-_______--.---.-- D' Box Type Filter Mafie al Depth Fil#erM teriai -- y- Distance tc nearest: Well _---________ __________ Foundation ----------------- ------ Property Line SEEPAGE PIT [ ] Depth ____________________ Diameter ____ ----------- Number _.-------------------- _____ Rock Filled Yes ❑ No Water Table Depth ----------------------- -----------------•....Rock Size ------ V --------------------- Distance to nearest: Well ____ ______________________Foundation __ __________--. Prop. Line ------------._.___-.__ REPAIR/ADDITION(Prev. Sanitation Permit# --------------\---------------------------- Date ----------------------------------- 11900 6 /4/- 1�rE' c-/a51 C& IVCD-CTB Septic Tank {Specify Requirements) ----------- - ------------- ------------------------------- ---------------------------.•---------------------- Disposal Field (Specify Requirements) ------6__-0_ �-T, _ ----------'-----------_l '-7` �-`,-- -T�'-----«----w --- ---------rY-��_n��- �-', 4 � T a r✓ 4y. I - I c I P r, g,C Draw exist-- and r- aired addition-y ---------------------------- ------------------ � _n a is r�r g a q ------------------------------------------------------------ on reverse side) I1hereby certify that I have prepared this application and that the work will be done in accordance with Sart 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 /fin. T-i `-�I + so� -------- Owner --------------------------------- ��- ------------------------------------------------------- ---- ------ Title -------------------------------- --------------------------------------- By {if otheA `owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ----- • f--° = --------------------------------- DATE --- y--------- - BUILDING PERMIT ISSUED ----------- ------------- ----- ------DATE ---_------------------- ------------ ADDITIONALCOMMENTI ------- - - ------- -- -- - -------------------------------------- ----------------- -------------------------------- -• ------ --- 1- 4 -------------------- -------------------------•---------------------------------------- - - _ ;-------------------------- ------- ---------_----------- -------- - ------------------------------ --------------------- ---------- ------ ----------- ----------- ---- ilZrr Final InspecTy3"' = '' ------Date - --- -- ----- -- ----- --- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M