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R OFFICE USE: APPLICATION FOR SANITATION PERMIT / -------- ----------- --- (Complete inTriplicate] Permit No.V-/-0--�-Q - ------------------------ --------------- I Date 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 existing Rules and Regulations. yf3 S.�oaEcs .47xff°'.- . JOB ADDRESS/LOCATION Cl,?` /-.1+1 7'- �P111 --, Q �1�- �----� �--S CENSUS TRACT 1-�5--0- _----- --- Owner's Name %C' 1 plf� l4l_�� • Aye---------------------------------------------Phone .��-��`�5�-------- � Address4W -�-;------------------------------ ------------ City --------------------------------------------- Contractor's Name -, CrC 5----.-- ----------------------------"----License #��2� Phone Installation will serve: Residence ❑ Apartment House❑ Commerciat ❑Trailer Court ;❑ Motel yj Other -------------------------------------------- Number of living units:---'---_._ Number of bedrooms .-- ------Garbage Grinder -- --.--. Lot Size --------------- %r,� F Water Supply:,Public System and name ------------------------------------------------------------- -- ---------------------------------------------Private ❑ rj�r _. Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat❑ Sandy Loam •❑ Clay Loam ;❑ (11 Hardpan ❑ Adobeg Fill Material ------------ If yes, type ---------------------------- C, I ]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,) PACKAGE TREATMENT ( ] SEPTIC TANKS Size_ jf_ __ ---------------- - Liquid Depth -y----_----- Capacity/2�vType/9"1 -527 ---- Material(ly40/z�. No. Compartments __�------------ ----- Distance to nearest: Wel! -�-----------------........Foundation ......149 Prop. Line __S_'1/------------ I LEACHING LINE k] No. of Lines __�---------------- Length of each line------TO ---- Total Length -------------- 'D' Box .`F�-__ Type Filter Material ,e%5 --_-..Depth Filter Material _ --------------------------- - --------------- Distance to nearest: Well ----7-f ------------ f=oundation ---/la__`--------- Property Line ---qe�7-------------- SEEPAGE PIT [ ] Depth ------ ------ Diameter ---------------- Number ---------------------------- Rock Filled Yes ❑ No ,0 Water Table Depth --------- --------------------------------------Rock Size --------- ------ Distance to nearest: Well ----------------------------------------Foundation -------------------- Prop. Line -------------_.-----.. REPAIR/ADDITION(Prev. Sanitation Permit# ----------------------------------------------- Date --------------------------;---.---) SepticTank (Specify Requirements) ------------------------------------------------------------)----------------------1--------------------------- ----------------------------- Disposal ------------------------------------------- ----------- )-------------------------------------------------...---------------------------- Disposal Field (Specify Requirements) --------------------------------------------------------- ------------------------------------------------------ I --------------------- --------------------------------- ----- ------------------------------------------------------------------------------------------------------------ ---------------------- (Draw existing and required addition on reverse side) I hereby certify that 1 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. Horne owner or licen- sed agents signature certifies the following: "I certify that in the performance of the work for which this permit is issued, 1 shall not employ any person in such manner as to become s ject to rkman's Compensation laws of California." Signed --------- ---------- -- - - ------ - -------------------------------- ------ Owner By ---------- - ----- ------------------------------------------------------ Title ------------------- ------- -------------------------------------------- (If r than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY --_.M0q----------------------------------------------------------------- ----- DATE 7_1 d-------- BUILDINGPERMIT ISSUED ------------------------------ -------------------------------------------------------------------- ---DATE ------------------------------------------- ADDITIONALCOMMENTS ----------------------------------------------------------------------- ------------- ----------------------------------- --------=--------------------------- --------------------------------------------------------------------------------------------------------------------- ------------------------------.-----------------------------------------;-------- -------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------- ---- ----- --- ---- - ----------------- --- - -------------------- - Final Inspection by-- ---------------------��2CV-0'lQ_--------_- ---------------------------------.Date ref? ------------------- ---- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M,