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.•y, -.AOR OFFICE USE: _ ,. APPLICATION FOR SANITATION iPERMIT ---- ---------------------•---- --------------- Permit No. ------------- O. (Complete in Triplicate) --------------------------------------- ------------------ Date Issued __,;12 --------------------------------------------------------- This Permit Expires 1 Year From Date Issued it 5 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 ADDRESSAOCATION �PZ-------/_--------- -- ----CENSUS TRACT -------------------------- ,p , Owner's Name _.__C,.�.-- ------A47VI?7----------------------?------------------------------- --------------- --------Phone��- ---'-- - - �----- Address ----X1/4 -------------------------------------------=-------- /--------------------- City Contractor's Name ----- ' / ' License #�j��, - --- Phone ? ----------- Installation will serve: Residence ® Apartment House❑ Commercial :❑Trailer Court !❑ Motel ❑Other ------------------------------------------- Number of living units:__-------- Number of,bedrooms _-3____--_Garbage Grinder _tVC1____ Lot Size _' U_�C___l�U_______________ __ v ' Water Supply: Public System and name o---------- --------------------------------Private i ---- -- -'; = , Character of soil to a depth of 3 feet: . Sand' Silt Cla ,,'.Peat Sand Loam Clay,Loam41 p ❑ ❑ Y 0 ❑ Y ❑ Y' lHardpan ❑." Adobe,'❑;$AFill Al terial ------------ 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,) PACKAGE TREATMENT [. SEPTIC TANK [ ] y , Size----------------------"--,.-- ---.-- Liquid Depth ------------------------ �jCapacitY ----------- -------- Type -------------------- Material----------- ----- No. Compartments ------------_--=--_ Distance to nearest: Well --------------------------•---------Foundation ---------------------- Prop. Line __-------------------- JI - ____ Total Len __________ LEACHING LINE,[ ] No. of Eines ______________________'_ Length of each line_.___________-_______.__ Length _.__.__________-- , �• 'D' Box ---1----.-- Type Filter Material --------------------Depth Filter Material ------------------------.------------------- "� l Distance to nearest: Well ------------------------ Foundation ------------------------ Property Line --______________-- ----- SEEPAGE PIT._, [ ] Depth t - Biometer ____-_--_--_ --- Rock..Filled Yes No 0 ro { ---- Number ❑ Water Tablle Depth ----- X------- ----- Rock Size -------------------------------- Distance ------------------------ -----Distance to(nearest: Well ----------------------------------------Foundation -------------------- Prop. Line ---------------- .. �-1 REPAIR/ADDITION(Prev. Sanitation Permit r# -------------------------------------------- Date ----------------------------------) SepticTank (Specify Requirements) ------------------------------------------------------------------------------------------------------------..__...--------------------------- 1. ,Y/�------- Disposal Field (Specify Requireents) ---- V------,1. 1 �'� 1Y�----f- �rU •r,�---- •�r`� -----------------------------------------------------I------- ----------------------------------------------------------------------------------- - 1 , ---- ---- ---------------------------------------------- ------------------------------------- ------ ---------- --------------------------------- (Draw existing and required addition on reverse side) 1 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 agents signature certifies the following: "I certify that in the performance of the work for which this permit is issued, I Aall not employ any person in such manner as to become subject to Workman's Compensation laws of California." r Signed -----------I--- ' -----------. Owner i - ---------- --- - -- ---------- -- ---------------------------- BY ----- -- ----- ---- - ---- ---------------- Title -------------------------------------- ---- --------------------------- (If other than owner) FOR .DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ------------ -- -- ---------------------------- --- - DATE ._�_ _. �{ BUILDINGPERMIT ISSUED ------------------------------------------------------------------------ ---------------------------------DATE -------------------------= --------------- ADDITIONALCOMMENTS ------------------------------------- ------------------------------------------- --------------------------------------------------------- ----------------- ---------------------------------------------- -------------------------------------------------------------- ----------------------------------------------------------------------------------------- -------------------------------------------- - ` ---------=------- ----------------- -------------------------------I` Final Inspection by: - '�'.- ----------- -------------------------------------------- ------------------------------------- SAN ----- - f kDare -Z71_ SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M.