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FOR OFFi�E USE: APPLICATION FOR SANITATION PERMIT Permit No. �- �'�-�- (Complete in Triplicate) - 4. ----- iDate Issued ------------------------- 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 in compliance with County Ordinance No. 549 and exiVing Rules and Regulations: JOB ADDRESS/LOCATION �UfI_--- .`- C1� p�t - A�-------------------------- CENSUS TRACT ----- ,, Owner's Name �11� ._��.�.-_�1/� !� �' -------------------------------- ---- - - -----• -----`-Phone Address --- pL/.___ �'-_ LRP�,tP?`- //1t ----------------------------- City��1f/_►r-x�----------------------------- .................. Contractor's Name _72-&X-440/---- -_--_-License U-- Phone<A"- ----------- -------------------------------------------- Installation will serve: Residence RKPartment House,E] Commercial ❑Trailer Court i❑ Motel ❑Other -------------------------------------------- __// Number of living units:---l---_ Number of bedrooms _"�......Garbage Grinder,010/. Lot Size ------------ Water Supply: Public System and name ----------------------------------------- -------------------------------------;'------------------------- Private [L}�� Character of soil to a depth of 3 feet: Sand'Silt❑ Clay ❑ Peat❑ Sandy;Loam ❑ Clay Loam;❑ Hardpan ❑ Adobe'❑ Fill Material ------------ If yes,type ------.--_-_-_--_-_--_---_ f (Plot plan, showing size of lot, location of system in relation to wells, buildings, etE. must be placed on reverse side.) NEW INSTALLATION: (No septic tank or seepa a pit permitted if p`ublic�o is available within 200 feet,) 6� PACKAGE TREATMENT [ ] SEPTIC TANK [ Size....L-_-_X.� -___ --------- Liquid Depth ------------------------- O Capacityx;;�_401------ Type --• - MateriA�14. - No. Compartments .__...�....... N Distance to nearest: Well /06--_---_______________Foundation �_Q_-._-___:_ Prop. tine .. �----.--- ,P� LEACHING LINE No. of Lines Length of each 'line----- Total Length /_�1��--------------- 'D' Box _4!-�--- Type Filter Materia;*��</<------Depth��//Filter Material / ----------------``---L-,------- -•------ Distance to nearest: Yfell ,:��----------- Foundation - --__----.--_ Property Line - --------------------- -- PIT [ ] Depth ----__- ------------ �idmeter ----------------- Number ---------------------------- Rock FiIhW Yes ❑ No 0 Water Table Depth '--------------------------- ----•--•----------Rock Size -----------•--------•---...----- ` Distance to nearest: Well ------------------t-- ------------------Foundation -------------------- Prop. Line ---------------------- REPAIR/ADDITION(Prev. Sanitation Permit# - ---.......... --..... ---------`--------- ------- Date ----------------------------------I } Septic Tank (Specify Requirements) ---- -------- -- -- .qf--------------------------------------------------,-..------------------------- -------------------- ------------------------------------------------------------------------------- { - -------------------- --------- ---------------------- (Draw existing an&requirl d 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: "1 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 l BY ----- --- - itle ri of 7o�/ ----- ----- -- ----- - -/------ 000ther than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY _.-_- Tt_ --_--_--_---_--____------. DATE ...,L�--� " --- Q BUILDING PERMIT ISSUED ----------------------- ----------------------- --------------------------- ---DATE ------------------------------ J ADDITIONAL COMMENTS _--__- _ , A----------------------------------- - -------- -------------------- --- ------ - -------------------- � � --Final Insp Date SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M