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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT -----------------------I------------- (Complete in Triplicate) Permit No. _7..1.�_.... --___-__--_.-___---------_------_-_---_-_--_--- 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 __..___--.__/� ',3__So_ _' ._ _ P'_ ___�"'1.; "___________CENSUS TRACT _-_---------------------- i " >g Owner's Name .1_ ./✓��I`>�-----��P�-��f----------------------- ------------------------------•------- --- -------Phone ---�---- ' Address -1-76--R 33- /�9 4" _ /__VVr �- X-------- --. City, `_ ' . Contractor's Name _ —.._..� � /__L_-C------------------------------------- License #c -7-�� 1�__ Phone � ................... Installation will serve: Residence N Apartment House❑ Commercial ❑Trailer Court Motel ❑Other -------------------------------------------- Number of livingunits:___ ____ Number of bedrooms _ /'�C'l2 �� --------------- r �.._..Garbage Grinder ____-___--._ Lot Size _______________ Water Supply: Public System and name .................................... ..........................................--------------------------------Private [�- Character of soil to a depth of 3 feet: Sand'PE Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ Hardpan ❑ 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,) � V PACKAGE TREATMENT [ ] SEPTIC TANK [ ] S17-` ______________/oundation -.-- .____.-_---__ Liquid Depth __-_--_--.--___-___-.--_- h Capacity -------------------- Type ------------------ . Material ----- ----- No. Compartments --------............. U(1 Distance to nearest: Well .-___________ __________________ at' n __________________._ Prop. Line ...................... VV LEACHING LINE [ ] No. of Lines _____________________-_ Length f each line _ ___- Total Length ------_----------_-.__-__-_ -------- --- 'D' Box ____________ Type Filter Materia -______--__-_-____ Filter Material -------------------- ----------------------- Distance to nearest: Well --------_____ __________ Foundat _ ------------------- Property Line .-_____-_--_-__---.-.--- SEEPAGE PIT [ � Depth -------------------- Diameter _ ______________ Numbe -_-__--________-__ Rock Filled Yes '❑ No i❑ WaterTable Depth ------------------ ----------------------------- ize -------------------------------- Distance to nearest: Well ________ _______________________________ ation -------------------- Prop. Line ...................... REPAIR/ADDITION(Prev. Sanitation Permit t# -------------------------------------------- Date ______--____________----_---______) SepticTank (Specify Requirements) ------------------ -------------------------------------------------------------- ------------------ --------- -------- --------------- --- Di/sposal Fielfd (Specify Requirements) ... _G-`_.G�_____________�'=7.11�_�------__ __�._____/`�_.� ___ ______ __�__________ -A o1-�j-------A)PIV_e------�-�'------- ��1 �� f�f►n �� f��`=f'�------------------------------------------------- -----------------------------------------------------------------------------------------------------------..--------------------------------------------------------------------------------------------- (Draw existing and required addition on reverse side) I hereby certify that 1 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 Wor n's Compensation laws of California." Signed - Owner BY - �� ------------------ Title ---------------- (If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ---------- __-__. DATE _____ail ........... PY"`:� - - - ----------------- ----------------- -- BUILDING PERMIT ISSUED -------------- --------------------------------------DATE ------------------------------------------- ADDITIONALCOMMENTS ------------------------------------------------------------------------------------------------------------------ -------------------------------------------- ---------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ---------------- ----------- ------------ ------ - ----------------------------------------------------------------------------------- Final Inspection b .- -_ 'Z�� "� P Y ►.�rt_..--------------------------------------------------------------Date ... ------ •��--'------ SAN JOAQUIN LOCAL HEALTH DISTRICT . E. H. 9 1-'68 Rev. 5M