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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT _ Q --------------------------------------------------------- 10 p p Permit No. (Complete in Triplicate) b 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. /Q7 J ------__-_-CENSUS TRACT ___� ---.- ____ JOB ADDRESS/LOCATION .---/L_v/'-9�-----`-�c---------�_L�F'D�_I------- ------- ----------- �------ Owner's Na`mekki---- /-I,Vella`4--------------- - --------------------.-----------------------I----- - -----Phone Address ---1 -�------/ //Z`�� - ------ •--- . City �'< kP ----- •..-•--••-- U ` " Contractor's Name . .. �� f' / --------------------------------License one � � Installation will serve: Residence Eg Apartment House❑ Commercial ❑Trailer Court Motel ❑Other -------------------------------------------- Number of living units:----T --- Number of bedrooms __ Garbage Grinder ------------ Lot Size _--___-.-_-_________________ _______ Water Supply: Public System and name ------------------------------------------------------- ------------------------------------------------------Private Character of soil to a depth of 3 feet: Sandal' 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---------------------- Compartments ................ ----- -.� Distance to nearest: Well --- ------- - ----------- ----- _..Foundation __ ----- - ----------- Prop. Line -------- - ------ o0 LEACHING LINE [ J No. of Lines ---- -- ---------------- Length of eac line-_--------_---- ---------- Total Length --------- .. "j 'D' Box --------- -- Type Filter Material _____ _____________Depth ilter Material ---------------.------ ---------.---.----•- ja Distance to nearest: Well ---------- -------- ___ Foundation ---- -- -- Property Line ________________________ SEEPAGE PIT [ ] Depth --------- ---------- Diameter ----- -- ------- Number ----- --------- -------- --- Rock Filled Yes ❑ No 0 V% 17 Water Table Depth ------------------ ------------------------ -•-Rock Size -------------------------------- Distance to nearest: Well ____ _________________________ ________Foundation - --- -------------- Prop. Line ...._...._..___....... REPAIR/ADDITION(Prev. Sanitation Permit# ------ ------------------------------------- Date _--_____________----------___-----) 1 Septic Tank (Specify Requirements) ------------- ----- ---------------------------•-----------------------------------4 Disposal Fi Id (Specify Requirements) -------------------------------- � - ------- ------------------ ---1 e- i ------------------- --------- ---- - --- ------ ------- -------------------------------------------- -- ------ (Draw existing and required addition on everse 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 - --- --- ---------------�-� Owner By -- - -- ----------------------- Title ----------------------------------------------------------------------- (If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY _77-1—R i---R ) ------- --------------------------------------------------------------• DATE . ............... BUILDINGPERMIT ISSUED --------------- - --------------------------------------------------------------------------------------DATE ------------- ----------------------------- - M - ---- ----------ADDITIONAL - ---------------------- ---- ------------------------------------------------------- ------------------- ------------�---------------- ------ --------------------- -------- --------------------- - -- ------- ------ ------------------------- ------------------------------------------------- ---------- - - - ------- ---------- ----------------- - -- - - -------- ----- - -- --- - - --- spctioO -- Date-----------Finallnen SA JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M