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FOR OFFICE USE: -- APPLICATION FOR SANITATION PERMIT / ' ----------------- --------=--------•------------------- Permit No: _. -= Sl (Complete in Triplicate) - ___ E' ----------------------------------------------_-----------f This Permit Expires 1 Year From Date Issued Date Issued _-9_- _"7`1 ,-Z — ZZA9— o/ 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: fl Coif 2"v, r� •4�orsE°! ' SFr C� s.vr c ivE c�.,r ,Q1?l;�a�e� , . JOB ADDRESS/LOCATION __ 11i7_._O`__-_ �ri3 !�ts-___ _ __-_ -.F�s' Ve _CENSUS TRACT _____._-____ ------' Owner's Name - , � © 1i---------� .------- / -----_- Cr__._-_ one __' . Address � % ` �9? —--------- ---- ----------- Y � -- --------- ------ N�` J Contractor's Name C'_ 77/, /_4 ------- # __ Phone _. e ------------------ Installation ---_ Installation will serve: Residence ❑Apartment House❑ Commercial ❑Trailer Court ❑ Motel ❑ Other ----- ---- w Number of living units ----- Number of bedrooms ____Garbage Grinder ------------ Lot Size -----9L5 Water Supply: Public System and name -------- -------------------------------------------------------------------•----------------------------------Private�` Charocter.of soil to a depth of 3 feet: -. Sand'❑ -Silt;[]' Clay El Peat E] Sandy loam F] 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: {No septic,tank or seepage pit permitted if public sewer is available within 200 feet,) I PACKAGE TREATMENT [ ] SEPTIC TANK;N' Size---------/__ Q__. ,,w---------- Liquid Depth ----------?�--____________ Capacity ./,;-v0------ Type *O'C-46'_: iToterial-Via------- No. Compartments _--_-7an_�_.._.__._.. Distance to nearest: Well ______--.-I ---------------------Foundation ------ D_`-__-___ Prop. Line _____S7J________ LEACHING LINE No. of Lines ______'Z -__._____ Length of each line----------- ------ Total LengthZ51 '.-..__.. 'D' Box kC ---- Type Filter Material ---1�r------Depth Filter Material -------------/ --"�----------_,------ Distance to nearest: Well _______________________ Foundation ------------------------ Property Line _______________' SEEPAGE PIT [ ] Depth --- Diameter _______________ Number ____________________________ Rock Filled Yes ❑ No ❑ Water Table Depth ----------------------------------------------- Rock Size --- --------------•------------- Distance to nearest: Well ----------------------------------------Foundation -------------------- Prop. Line ...................... REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------t------ Date ----------------------------------} Septic Tank (Specify Requirements) -------- ---------- -------------------------------------------------------------- -----------------------------.. . DisposalField (Specify--------------------------------------------------------Requirements) ------=---------------------------------------------------------------------------------------------------------------------------- -- -- ------------------------------- -------- ---- - --- - - - -- ---- ----- - - I (Draw existing and required addition on reverse side) s I 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, 1 shall not employ any person in such manner .":1k. as to become subject to Workman's Compensation laws of California." t� Signed...... /51�- --------rL4----.--e-�--C-��---.^� -s--'Owner t BY ------------------' ------------- i7itle f (If other than owner) �" FOR DEPARTMENT .USE ONLY: BUILDING PERMIT ISSUED ------------`- -f-_ - -,-i- " DATE . ��`�~ --- ' APPLICATION ACCEPTED BY ---- ------------A--DATE ----- ---- t ` " ADDITIONAL COMMENTS ---- - ----------------- ----------------- -------------_-_-_-_-------------- --- ---------`---`4 - __________________________________ _ _ ______________________----------------------------------------------------------------------------- f -------- ------ --- ----------------------- '__._____________________________________ ____ __ __________ ---- __________ _______ ____-------___.____ ---------- ____ __ i _ _ _ ___ ____ ---- ---- - y r ----_. _________________ ___ _ __ ____-______ _-- - -'----- ` -- Final Inspe b T Date SAN JOAQUIN LOCAL HEALTH DISTRICT .� E. H. 9 1-'68 Rev. 5M f 1