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FOR OFFICE USE: X APPLICATION FOR SANITATION PERMIT ---------------------------------------- - �_-��'....(Complete in Triplicate) Permit No. _7 ___.__.._____.___- _.______________.._ This Permit Expires 1 Year From Date Issued Date Issued __ Application is hereby made to the San Joaquin Locall�Health District for a permit to construct and install the work herein described. This application is made in compliance ��m99 ith County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION aS__S. /1 --- - - - -- - --- --RPV_R --------6_I�1Q� --------------CENSUS. TRACT --��-�-�-------- Owner's Name ---- ---1LIr ---- 1 IO/��A L _ --- - -Phone -- p Address -------- --- �Q0_,SS- _ !_�_� �_ City -- ------------- Contractor's Name _t�1 ORP N---'----RASH_ �_R��_License # Phone Installation will serve: Residence Apartment House❑ Commercial ❑Trailer Court ;❑ Motel' ❑Other -------------------------------------------- Number -Number of living units:________ Number of bedrooms 3-__-__Garbage Grinder WO Lot Size ------ -------- Water Supply: Public System and name __ --------------- ______-Private, --- --- ----- ---- --- - ------- --------- -------- -- ------------- - Character of soil td'a depth of 3 feet: Sand''❑ Silt❑ Clay,[i Peat Sandy Loam R— Clay Loam ❑ 4-I4Crrdpan [ ~Rdobe'Q Fill Material ___V__ If_yes, type _____ ..______ _ ------ Q (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) Q� NEW INSTALLATION: (No septic tank or seepage pit permitted if pVblic sewer is available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK [f Size------ �__.___--_- Liquid Depth _.__ Capacity `1®_Q._:_ TypePREC.OSr Material_CD_ RJE7;1= Compartments �..,_.- istance to,nearest::Well _-_- ___�_ _______ __ _.Foundation ----!Q---------- Prop. Line ------ LEACHING LIME [ No. of Lines .---�_____________ Length of each line________�I-_�_---____ Total Length ______-----4. __. .•.____ 'D' Box es-� Type Filter Material 80iCn&___Depth Filter Material ____L9____-________________. ........ Distance to nearest: Well __--- ----------` _ Foundation --- _______ Property Line ---------_______________ SEEPAGE PIT [ ] Depth __- Diameter ________________ Number ---------------------------- Rock Filled Yes '❑ No Water Table Depth ----------------------------------------------Rock Size ----------------------------•--- Distance to nearest: Well ____ ___________:___-______-______;..._Foundation -------------------- Prop. Line . :____-_____-___-___ REPAIR/ADDITION(Prev. Sanitation Permit# ------------ ---- __________ Date ---------------------------------- Septic ___________________._-__-_ ____Septic Tank (Specify Requirements) ----- ---- --- ----- -- -- --- -------- --------------- ----- Disposal Field (Specify Requirements) ________ � t -------------------------------------- --------------------------------------------------------------------------------------------- --------------1--------------------------------------------------- (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 Workman's Compensation laws of California." Signed Z- Z ?-z-- `t"T ner BY --J ' t� C'' ----- ---- ----- Title ------ ------ (If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY --------T`---R.-O---------------------------------------------------------- --------------. DATE ---- -` — 71------------- BUILDING PERMIT ISSUED ------ ------ ---------------------- -----------------------------------t---------------DATE ---------------- --------------------------ADDITIONAL COMMENTS ---------------- - ,_ -------------------------------- - � , Final Inspection ____ Date - _ .__ . SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M