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., FOR-OFFICE USE: t APPLICATION FOR SANITATION PERMITV 7 j- (Complete in Triplicate) Perna it No.i _______________________________--_________.___---_-_-_ This Permit Expires 1 Year From Date Issued Date Issued _. _ __._..... , Application is hereby made to the San Joaquin Local Health District for a permit to construct and install t4 work herein ' described, This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION --- ---�- 47' =---j-- ` � --- ----- - ---------------------CENSUS TRACT ---------------------- ` Owner's ,Name [` U t l - Q - ----------------------------------------------------Phone ..46-6__0-7/r_______ AddressG-----------�-V-V-----------------. City -----5.I-U Ca_tf ro_-n--------------------- ------- --------- e r _ ---- Contractor's Name�.�ca._CISsz.�` � �_ _ ___ __1_ _ _ ___ - �__ Phone �- _-- � �_ - -�---Y)� _.License # -�_��a�_ Installation will serve: Residence 0 Apartment House ❑ Commercial ❑Trailer Court Cl Motel ❑Other -------------------------------------------- ! Number of living units:___ .__ Number of bedrooms _____Garbage Grinder _1W_ Lot Size ________________-___-___________________ 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 ❑ Adobe Fill Material ---------- If yes, type ---------------------------- Plot I plan, ________________.______PlotIplan, 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'[g Size_ �'` �' � � -------------------- ---- -�- �- - -- Liquid Depth -------�.�•..__...__ � Capacity _44zp Type ---_____ -- Material_eAv1_'1"r_Ie__ No. Compartments _----�.......... ' ! i Distance to nearest: Well ________ CS _________________Foundation ________ Prop. Line ---,. �©:.......... �f LEACHING LINE p(J No. of Lines ---------!�L---------- Length of each line-____. ------------- Tota! Length _.�. 11.......___.. 'D' Box ---- Type Type Filter Material -----0_"-_____Depth Filter Material _____-/. -_`f______________f______-_ Distance to nearest: Well ---- ---------- Foundation ____3-b----------- Property Line ---_1Q____-_._-___ SEEPAGE PIT r Depth ____ Diameter __ _f' Number _.________-,�____-_______ Rock Filled YesNo Water Table Depth -----------9�--------------------------- � ---•------Rock Size ----------- _ ------------------ Distance to nearest: Well -------/P�P------------------------Foundation ---?04?_---------- Prop. Line ____,h__......... REPAIR/ADDITION(Prev. Sanitation Permit# -------- --N-0---------------------------- Date -------- '__-____,_ ----________) Septic-Tank (Specify Requirements) ---- --------------- --------------------- ------------------- DisposalField (Specify Requirements) -----------------------------=------------------------------------------------------------------------------------------------=---- -------------------------------- -- --------------------------------------------------------------------------------------------------- ----------- ----- -------------------- l (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 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 F as to become subject to Workman's Compensation laws of California." ` } Signed - --- --- ------ Owner ---- By _.> .* '-�------------- -' --- Title -'-----'--- - - '--------------- (If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ..—r__ DATE ._...___ -` BUILDING PERMIT ISSUED - ---- / ------------------------------------ ----- ---- ---DATE ------------------------------------------- -- ------ ADDITIONAL COMMENTS ______________ --------------•------------------- = ,---- -------:- -:__ -- _ - _, -� �� -------------------------------- ----- -------- ------------ ----------- =--- - ------- -- --- -------------------------------------- - - - - - -- ----- - ---- ---- ---- - -------- - - --- ------ -------- Final Inspection by ---- = Date SAN JOAQUIIv LOC HEALTH DISTRICT E. H. .9 1-'68 Rev. 5M