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- a FOR OFFICE USE: APPL1 ATION FOR SANITATION PERMIT - -- - Permit No. � ' -�.5.eZ -------------------- (Complete in Triplicate) al Date Issued �_�. %7 G ---------------__________-------------------_------ This Permit Expires 1 Year From 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 izn-�compliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION 0"___L_/_-,_S______�Ifzpodn ----W --------------- --CENSUS TRACT ----- ------- Owner's Name J_S_1/,W—il --1 ;.6 t!41l( ->- .Cllr 1lG�r�,,5��----1------------Phone- ---- City ------ -- -- --------------- Address _�_�_ _ l <lj�?�hcfU ------------------------- �j ,y2 Contractor's Name .-____ > .-__C ?->Z'-_/__/ -' '-----------------------------------License #p'`_Y (--a-- Phone Installation will serve: Residence fo Apartment House,❑ Commercial ❑Trailer Court l❑ -Motel ❑Other ------------------------------------------ Number of living units:__________ Number of bedrooms _a.....Garbage Grinder ------------ lot Size -_____-------------- Water Supply: Public System and name ------------------------------- -•------------------------------------------------------ ------Private Character of soil to a depth of 3 feet: Sand fg Silt❑ Gay ❑ Peat❑ Sandy Loam lay 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 seepa pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK [ Size---_,-.3�__ x-t-f.JI-(7-C-U1 ____ Liquid Depth __ �—--------_.._. Capacity __,__ Type _ Material. -w�1 {No. Compartments P-7............... istance to nearest. Well ---- ---6 ___________________Foundation ---1_d....._...... Prop. Line ----::5 \ Total Len � --- --_-- /� LEACHING LINE [ No. of Lines ____ ________________ Length of each line------- _.-_____------ Length .--- rA y 'D' Box ------------ Type Filter Material X _ --Depth Filter Material __.tf__________________________________ Distance to nearest:' Well ______6 _f_____ Foundation _____�_ 4_ ___. -__ Property,Line __ ............ SEEPAGE PIT [. ] Depth Diameter _ ___________ Number Rock Filled Yes ❑ No i❑ Table Depth----------------------------- Water -- -- -- -.Bock-Size --- ------------------------- Distance to nearest: Well ____________ __________'---------------Foundation -------------------- Prop. Line ...................... REPAIR/ADDIVON(Prev.-Sanitation Permit# _________________________________________ Date ______________________-_______-__) Septic Tank.-,.(Specify Requirements) ----------------- ------------- - Disposal Field (Specify Requirements) __ v lrR D S- - mrr ____ -_. _ .__-70 31� __________ _.---------------- --------------------------------------- ;_____________--------------------------------------------------------------`70- 3-!R--------- ((9c�_D------------3 - 7 ---------------------------------------- ------------------------=-----------------I--------------------------------------------------------------------------------:--------------------------------------------------------------------------- (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 Wor man's Compensation laws of California." Signed - -Ath --- -------- - ----------------------------------- Owner _ BY ------------ ---`---------^--- ------------------------------- Title ------------------------------------ ------------------------------------ (If other ,9n ovine r FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ______________.___-_ __ DATE _:____ - BUILDING PERMIT ISSUED __---------- - .--DATE —--------------- -------------- --------- ADDITIONAL ----. - ------- ADDITIONAL COMMENTS -- -- -- ------- - ------ - ------ ---- - ---- ---- ---- -- ----- ------ ---------- ----------------- - ------------ ----------------- -- -------------------------------------------------------- -- --------- --------------------- ---- - -- - - -- --- ------ -------------------------------------------- -- ------ ----- - -- -- --- -- Final Inspec i ----- - - - -- -- - --- ----- ------ ----- - - ---- -----' ------------------------------Date Z _-_.----'�- `. SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M