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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ---`-- Permit No. ...�3�_7�._ \ (Complete in Triplicate) ----------- Date Issued --------------------_.___.-___-__---- ___-----___. This Permit Expires t 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 existing Rules and Regulations: 'ZZ 1 3 r�— �_= ----- i_F1��_O__1-,- I!'�r` - -----•----CENSUS TRACT ---- - ----- JOB ADDRESS/LOCATION .tt_-__________-____ Owner's Name ---------------aLE _� -------i4 ,Q J' .-t9---------- ------------ ---------------------- --------------------Phone ------------------------------------ Address -------------�'�__24-3--5------------I-------AJ_R fo_ --_- --_-.. City -------`y-AWA-TZCl0---`-------------------------------•-- Contractor's Name ---40-VA1ftj-h CL_------------------------------------------------- -----License # ------------------------ Phone .............................. Installation will serve: Residence 2'12cp-artment House,❑ Commercial [-]Trailer Court f Motel ❑Other .------------------------------------------ Number of living units:.-.-_/_____ Number of bedrooms __-.....Garbage Grinder/ _;3_ Lot Size _19-03FAC_ --------------- Water Supply: Public System and name _______________________ ---------------------------------------Private Character of soil to a depth of 3 feet: Sand'❑ 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,) U PACKAGE TREATMENT [ I. SEPTIC TANK[ ] Size------------------------------------------------ Liquid Depth ----------------- -------- Capacity ----------------- Type ------ Material---------------------- o. Compartments --------- ............ W Distance to nearest: Well ___-.__________________________Foundation ------ --------------- Prop. Line ...................... LEACHING LINE [ ] No. of Lines ------------------------ Length of each line------------------------- -- Total Length ----------- ................ D' Box ------------ Type Filter Material ____________________Depth Filter M teriai ___________---____-_____.------.,_..-;--.- Distance to nearest: Well _.-_ ------------------- Foundation __________________ ____ Property Line ........................ SEEPAGE PIT [ ] Depth ------- Diameter ---------------- Number ------.--------------------- Rock Filled Yes '❑ No C] Water Table Depth ---------- Rock Size --------- •-------------_---- Distance to nearest: Well ___I _________________________________Foundation _____ ------------- Prop. Line ...................... REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date -_----------._-___.______._.-.____) Septic Tank (Specify Requirements) ----------/ f/-6- ------ AL--------;5_r_1;9rC------•--14IN,-)5�,I----•-•--------------------------•-----•- Disposal Field, (Specify Requirements) --3--------------- -------------4155�, -4W-------//-1vf�-----------------------•--------------- -----=--------------------==--------------------------------------------------------------------------------------------------------------------------------------------------------------------------- --------------------------- ------------- ----------------------------------------- -- ----------------------------------------------------------------------------- -------------------------- .. (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 ageA signature certifies the following: ' "l certity tat in the- erfor nce of the work for which this permit is issued, I shall not employ any person in such manner as to b o e subject to o man's Compensation laws of California." Signed - ------------- - ---------------------------- - Owner By -- ---------------------------------------------------------------- Title -------------------------------------- --------------------------- (If other than owner) -� FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY v i `r `------------------------------------------------------------------ ------ DATE ----- - '.. -------- BUILDING PERMIT ISSUED ---------- ---DATE ----------------- ADDITIONAL COMMENTS --- ----------------------- ----- --- -- ---- - -- ----- ------------- ----------------•---------- j s - - -- - -- ---------- ---------- --- ---- - - Final Inspec G ------ --------------- Date __— - `� -� - --- - i % lel SAN JOAQUIN LOCAL HEALTH DISTRICT T E. H. 9 1-'68 Rev. 5M