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FOR-OFFICE USE: ' APPLICATION SANITATION PERMIT .... . ------. r ` 1 ) �_ permit No-_. f ; (Complete in Triplicate) -------------------------------.------------------------ � This Permit Expires 1 Year From Date Issued Date Issued I -s 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 ADDRESS/LOCATIONI ` rN _ - ----- ---------- -- CENSUS TRACT -------------- ----------- Owner's Name 63lr 19EjT1 --•--•------- --------- _ --------Phone Address - - --------------------------------------------- `-- ,... City ----------- Contractor's Nameft'ulC'----------_.License # ----- �- - a Phone ------ Installation will serve: Residence P91Gpartment House-❑ Commercial :❑Trailer Court ❑ Motel E]Other ------------------------------ i----------- K !,/ Number of living units:___ bedrooms -A_.____-_ Number of bedroom _ �_mm :Garbage•Grind6r-/f/0___ Lot Size _r�_00------- Water Supply: Public System and name ----------------------•---------------------------------------------------------------•--�`---------•--------Private ®-`- Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay .❑ Peat ❑ Sandy Loam ❑ Clay Loam )Hardpan D Adobe'[TFill 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.) t� t NEW INSTALLATION: {No septic tank or seepage pit permitted if public sewer is available within 200 feet,) � -' PACKAGE TREATMENT [ ] SEPTIC TANK[ J Size___5�i��, ___ � __r______________ Liquid Depth -------- Capacity _._.__Capacity /�7dp - Type 7,-,*r4AA__ Material_6-V_/_Y6AW No. Compartments Distance to nearest: Well ______`��__-______________ t Foundation l Q Prop. Line -S LEACHING LINE [ ] No. of Lines1 =---- � . ___________ Length of each line------3�a-- ____._____ Total Length ------X®- 'D' Box ----" _�-___ Type Filter Material -__Depth Filter Material ------ [ Distance to nlearest: Well ------- Foundation Foundation ___ f__.-__." Property Line ---------------___:.___ SEEPAGE PIT [ ] Depth __-12-5 ------------ Diameter Number ---------------------------- Rock Filled Yes M No 0 Water Table Depth ---------------------------------------=--------Rock Size -------------------------------- 0' ------------------------------- Distance to Barest: Well ______ ��--------------------- r , It - - -------------------------Foundation �------------ Prop. Line ---------------•-•-•-• w ► , REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date ---------------------------------- Septic ---- --------------------Septic Tank (Specify Requirements),___---_ i1 ------------------,)------- DisposalField (Specify Requirements) --------------•------------------------------------------------------------------------------------------------------ ------ ------- -------------- --------------------------- -----------------------------------------------------------------•--- - --------• -------- --------------- � r ! 1 (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 Sart Joaquin County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District, Home owner or !icer- k 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 sub"ect to Workman's Compensation laws of California." p Signed------ -- --=----------------------------- Owner By ------------- ----------------------------------------- I---------------- Title- (if other than owner) ! FOR DEPARTMENT USE ONLY � APPLICATION ACCEPTED BY--% --'_ '-"---"_____ ''�_______._ DATE __.�0 ) -------------------------------------------- ------ BUILDING PERMIT ISSUED ----------- ---' `----------------------------------------------------------- - , ------=--------------DATE -------------•-------------------------•--- ADDITIONAL COMMENTS -------------- !-._________________ _ t -------- -------------------------------------------------------- - -F----------_:_-____---- - -----G-*-------I- -`� =6� � ��---------- ----------- - - ------------ --------------------- -------------------------------------`'-4- i ----.------- Final Inspection by-, ----------------------- - ........ [ ------------- ----------------------------------------Date _j6 .-b_-•_. . ; L----SAN-JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M t