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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT _ ----- -------------------------- -- ''- �-------- I Permit No: �-- ---=-�� (Complete in Triplicate) ' ---------=--------------- ----------------- -------- 4o o-l I ~ti a Date Issued .................... �-ex-- `�.._ .P ,' This Permit Expires-1 Year From Date Issued : y Application is hereby 4,6de 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: �.V1 ,( = JOB ADDRESS/LOCATION . �I �,Id' 1 � �i � ----- -CENSUS TRACT ' - *s - OwnersName - -. .�z�d,� ----± -.------ ---------------------------------------------------------------------------- -------- --- ------Phone ----------------....--••-------- _ .�C f . - .Q -----. Cit119J ` - ---------- ------ ----•-------------------- Address -------------------�� - - - -- - - - - -i-- ---- - -- --- Y � �j �,/ Contractor's Name --------� -W�----------------------------------------------------License #2�.7 �__ PhoneGt - ------------- Installation _�� -- Installation will serve: Residence ❑ Apartment House❑ Commercial :❑Trailer Court Motel ❑ Other ___ 0��% `__ p Number of living units:_. ------ Number of bedrooms f9-----Garbage Grinder --'--_ Lot Size f�__w- -•------.-.•---- Water Supply: Public System and name ----------------------------------------------- -------------------------------------------------- ---------------Private Character of soil to a depfh of 3 feet: 9and'[ �Silf[] Clay ❑y 'Peat❑ Saridy'Loarn ❑ Clay Loam;❑ IHardpan ❑ 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 septi tank or seepage pit permitted if public sew r is available within-200 feet,j 1 , UU __ .._. PACKAGE TREATMENT ( ] SEPTIC TANK Size__ -__X._.- --- T ---.- Liquid Depth_-/_ �� /z --------- T, T + No. Compartments ....... ...CapaeitYlet � aterar4A :.... Distance .to nearest: Well -- .--__-___ _'______--.-Foundation _--fes______-.___ Prop: Line } ______...... LEACHING LINE [ No. of Lines �________-------_ Length of each line__,7Q.--_______---__s Tota Length 4*0_0................ 'D',(B,ox y, __ Type Filter M�lateria`„ S�_C _.Depth Filte� Material Sf_______________________�____....... Distance to nearest: Well ____1�r Foundation, -4 -:n--Property°-Line-Z-1.5—--------------- SEEPAGE PIT [ ] Depth -------------------- Diameter- -- _--.-- Number --------------------- --- -,•Rock Filled"M�!esj❑ No 0 Water Table Depth .a --- ------------------------------Rock Size -------------- ------=-••--•-- ` Distance to nearest: Well ________________________________________Foundation -------------------- Prop. Line f----------...._...-_ REPAIR/ADDITION(Prev. Sanitation Permit# ________-____----------------------------- Date ____---.____.:_______.__._.-_-----j g I _ I R I Septic Tank (Specify Requirements) ---------------- -------- ----;-------------------------------------•-----------•------------------- -------------------- Disposal Field (Specify Requirements) ------------i---`- -- -- - ------------' `- ii ! � _ __________________________________________1.______.____-_---______. ____________ --------------------- ; [Draw existing and required addition on reverse side) I hereby certify :that l 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: "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 subject to Workman's Compensation laws of California." Signe __ __ Owner ABY - ' " W� ----- --------- ---------- ------------------------------- Title _ 16� � 1 .�x111 p (If other than owne FOR DEPARTMENT USE ONLY N,// APPLICATION ACCEPTED BY _.__I_'41G1:_------ ------------------------------ DATE --Q_=- =•- -. ----- ------- BUILDING PERMIT ISSUED ------- t ----DATE ------------------- ------ -------------------------------- ------- ADDITIONAL COMMENTS ---- ! = rr - -- -----------------------------------=------------------------------- -------------- - -- �. - --- ---- ---------- -- -71 ------- ---- ------------ ----- --------------- -- ----------------------- ----- - Final Ins e� Date ---- --`---- ---- ------ ------- - - - -- --------------------- -- - - SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M ,