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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No. -AVO— '�C`_L - - - - --------------------------------- �./� (Complete in Triplicate) _-------------- ,._. ----------------------------------- w'This Permit Expires 1 Year From Date Issued 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 r��- � � _ -_ .BC ----CENSUS TRACT _____._6______________ Owner's Name ---��b MH �tf � �- - = ' ----------PhoneS,Zj"S,3wT- Add ��ress /"-& ------5- - D11�'__-. _-- _ -- -- _ .�'_'�_'.7City --- �--_ Contractor's Name - ----- k3,l�l-r`1i.f� ------License # - -------- ------------ Phone l �P^ T__ Installation wi[I serve: Residence ❑Apartment House�Commercial ❑Trailer Court F1 Motel ❑Other ----------------------------- w, lumber of hvmg units._ _ "Nif�r '"of` Brooms __-__Garbage Grinder �6 -_- Lot Size _-__ ! ----------- ,..<.. Water Supply. Public System d name - - Private Character of soil to a depth o6 feet Sand'❑ Silt`[] Clay ❑ Peat❑pp m Sandy LoaClay Loam ' Hardpan F ' Adobe ❑ Fill Material -NIV- 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'[ ] 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' 'Box ---- __--- Type Filter Material --------------------Depth Filter Material ----------------------------- ---------- V z Distance to nearest: Well --------- Foundation .----------------------- Property Line __-_________________-___ SEEPAGE PIT [ ] Depth ---------------.,.r._ Diameter ________________ Number --------------------------.- Rock Filled Yes ❑ No i❑ Wate Table Depth '-----------------------------------------------Rock Size ------------------------------- Distance to crest: Well ----------------------------------------Foundation -------------------- Prop. Line ___________________-_- REPAIR/ADDITION(Prev. Sanitation Permit# - -____________-__ Date _ __l5�- 7___________),�,,CG�w�o *:-7f 7 Septic Tank (Specify Requirements) 4-^-•- ------------------------------------------------- I ---------.----- ------------------------------ DisLosal Fie (Specify R quirem�nts) _____1_--_ -- -,6 ,_____ ®_ i ,i.; ____ _______.d-L44)--------------------`------------------------------------------0------------------------------------------------------------------------ ------------------------------- --------------------------------- 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 Reg?lations 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 be su ect,to orkm s Compensati laws of California. �y i ^'� Sign --- - - 1 � a t By -------------------------------------------------- ------ -- -----. , tle ---------- ------ ---- ---- ----------------------------------------------- -------------------- (if other than owner) i' FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY 1�s -------------------- ------------------------------------------------------ DATE ---- - J -------- BUILDING PERMIT ISSUED ------------------- ---------------------------------------------------—-------------- ----------------DATE ------ ------------------------------------ ADDITIONALCOMMENTS ---------- --------------------------------- ----------------------------------------------------------------------------------------------------- - ---------------------------- ------ -- ----- ------ - ---- ------------------ ---------------------� --- - ------------------ ---- -- ----- --------- ^--�� t� Final Inspectiby' v -------------------------------------------------Date ---------1--'1 / ------- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1 '68 Rev. 5MAc�J , 93 �� ,S- :2,