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FOR OFFICE USE: Fav t APPLICATION FOR SANITATION PERMIT 11 (Complete in Triplicate) Permit No. ------------------- This This Permit Expires 1 Year From Date Issued ©ate Issued 0 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. P49 and existn' g,Rules ckrid Regulations: JOB ADDRESS/LOCATION,__ G.-11 No'e----�- . ��i4w- _ - -- /��,Q �- � !�- - WrI/,�3�/--- ---------- - -OaI.l1�- �_rS�. ----..CENSUS TRACT -..�---`-��------- Owner's Name --- G _o<. �s� _li7ls ----------------------------------- f - --------- ---------------------Phone ------ --------------------------- W_�4`�~ - - CV--Aaeva--------------------------- city Address _ �r� Contractor's Name ---------- License # -- 4 � r-Phone ------------------------•-• - Installation will serve: Residence ❑Apartment House ommercial ❑Trailer Court ,❑ Motel ❑ Other -------------------- Number of living units:--- ------ Number of bedrooms ------------Garbage Grinder ------------ Lot Size ---------------- _ __---_------- -_-----_ Water Supply: Public Syste� and name -------------- = ----------------------------------------------------------------------- -----------------Private ElCharacter of soil to a deptIll of 3 feet: SandEj 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: iNo septic tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT ( ]� SEPTIC TANK:[ ] Size------------------------------------------------ Liquid Depth ---------------- .._.-.-.. gj Capacity -------------------- Type -------------------- Material---------------------- No. Compartments ---------------------- Dilstance to nearest: Well ------------------------------------Foundation --------------------- Prop. Line ---------------------- LEACHING LINE [ j N , of Lines ---------- -- Length of each liner------------------------- Total Length ,--_----_----_-_.---_----__ 11 'D'`, Box ------------ Type Filter Material --------------------Depth Filter Material ------------------------------------- ------ I� - Distance to nearest..-Well ---------------------.-- Foundation ------------ -------- Property Line ----____----_-_--__--_ i SEEPAGE PIT ( ] Depth ------------------- Diameter -------------- Number -------------- ---------- Rock Filled Yes ❑ No i❑ Water Table Depth ------------------------------------------------Rock Size -------------------------------- O Distance to nearest: Well ----------------------------------------Foundation -------------------- Prop. Line ------_-__-_--_-----_. REPAIR/ADDITION(Prev. Sdnitation Permit# -------------- -------------------- ------ (/ ` Date -----------------•------------------11 Septic Tank (Specify Re Iuirementsl � ) 7 - Disposal Field (Specify ------------------------------- ----------------------- -------------- --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- (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 Jaws, 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.:._ubje t to h�rkman's Compensation Paws of California." Signed - �� Owner BY ------- ..��' ----�------- ------- -------- --- ----------------------- - Title . --- --------------- (If other thanlow ' FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY -------..46-6 49- -- ---------------- ------------------------------- --------- -- DATE ...... -------- r BUILDING PERMIT ISSUED'. --- DATE -.. -- ----- ----- ADDITIONAL COMMENTS _!r---.-- .-_ - - iI •0-— - -- ---------- -- ------------ ------------ -------------- --------------------------- ----------------------------------------- - ------ ----------------------!7-----------------------------(= 1- rr-_ -- - - �--� ---- ---------------------------- / --------------- � �`0---------------- Final In �ection by - -- - ------------------ Date �72 SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M