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FPR OFFICE USE: APPLICATION FOR SANITATION PERMIT y r - l ----- (Complete in Triplicate) Permit No ----------------------. XDate Issued 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 in compliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCAT ON .__30 2.6-L____S_,____ ------AM-fl--CENSUS TRACT -- _ ..1_---__.-_ / --------------------f4 - Owner's Name jig --- _PC-A-1-�Ihl 1'}I�i_��. C. L✓ z = Phone Address -------------1 g-----------Is------ �•N-eo-LlJ- ---------------------- city ----M )- A-+--- r=:_' r�i-431 /�! — ---License # ---- -: ----------- Phone ------------------ ------ Contractor's Name _�_[�T �-----�----- -- _ ��------ --------------------- Installation will serve: Residence partment House❑ Commercial ❑Trailer Court !E] Motel F1 Other -�-------------------------------- -- Number of living units:________ Number of bedrooms -Zr---Garbage Grinder _ ___ Lot Size ----/4f3_h19G _-_--___-_ Water Supply: Public System and name --------------------------------------------------------------------------------------------------------------Private Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat❑ Sandy Loam 2-`* Clay Loam ❑ Hardpan ❑ Adobe 'a Fill-Material --AIV--- If yes,type -------------_------______ (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) vV NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) Q PACKAGE TREATMENT [ ] SEPTIC TANK [ J Size---- -------------------------_-:____--__--- Liquid Depth --------------------------- Capacity ---------- Type-------------------- aterial-- - --- No. Compartments' _.................... Distance to nearest: Well --------------------------------------Foundation ---------------------- Prop. Line ---_-_- .............. LEACHING LINE [ ] No. of Lines ------------------------ Length of ach line__________________________ Total Length ----------.................. 'D' Box ------------ Type Filter Material ------ -------------Depth Filter Material -------------------_........................ Distance to nearest: Well --------------- -------- Foundation ------------------------ Property Line -_-__---:---_-__.____-- SEEPAGE PIT [ ] Depth ____________________ Diameter ---------------- Number,_--------,------------------ Rock Filled Yes ❑ No i❑ Water Table Depth --------------------------------- --------------Rock Size --'-------- -- ------ Distance to nearest: Well ------------------------- --------------Foundation -------------------- Prop. Line ...................... REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------- ----------- Date ---------_--------_--------------) Septic Tank (Specify Requirements) ----- ------ ----- ----- ---- -------- - ------------------------- Disposal - --------- ----- Disposal Field (Specify Requirements) _-_--_ --_ --1 i_ 01 L----- .hT4 -- _-_- ---. --t1'A`t-- -::----- 1 Z 1 _4 'l? t s t� = � x 1 - ='r E�.�----------- 4---1.0- -'r-CSC t-f Ao---------i-XJ--1 l l_N-C1--- --1 8.( `f=_-----4-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 � accdrdcjnce 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 Workm/(a#s Compensation laws of California." e.. Signed ----- 2=r� ��L�t_ �, -- - -------- --- --- Owner -- ------------ - BY - -- ------- --------------------------------------------- Title - - (If other an owner) , FOR DEPARTMENT USE ONLY ` APPLICATION ACCEPTED BY -----'�._R_-0 "_-__ ----.'DATE _I'� Z�.-d/ -�- ----- ---- ---- ---- -- - - - - BUILDING PERMIT ISSUED ----------- _ DATE ---- - ADDITIONAL COMMENTS -7d 7N1'� _� � - - --- ------- -- - ----_` -1- �L � �� Y�1 ----- t1 -- 1�=-------��-U-�------®'-�-`------��-------_--IV�'�----� -- -------------- -------------- - - ------ 0 J Final Inspection by: - ---------------------------------- JO ----- - ----------------- Date ' JO Ul LOCA HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M