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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT f i (Complete in Triplicate] Permit No. .69-_f�U -- ��--------------------------- This Permit Expires i Year From Date Issued Date Issued Application s,hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. Theis application is made in compliance with County Ord'in/ance No. 5.49 and existing Rules and Regulations: JOB ADDRESS/LOCATION /�9'�---- ��_�-�i C // A�►"� 'IA/1$T G4 i--CENSUS TRACT ---6------------------ - � �Owner's Name <Z 73 - ------ one Address .. 11►s¢ _l f`�--------------------------------------- City /1ftAfQ1!��_CQ L_lJ ` Contractor's Name -- -•�.?��4�-_----.��/��----I�ri1✓il`�-----------------License PhoneeP - - •------- Installation will serve: Residence 0-KIPartment House-[] Commercial ❑Trailer Court ',❑ Motel ❑Other Number of living units:-___/----- Number of bedrooms -----Garbage Grinder*?�-_ Lot Size -___________- Water Supply: Public System and name ---------------------------------------------------------------------------------------------- ------Private a'_� 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 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 seep a a pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT "f [ ] SEPTIC TANK'[ Size_ X1l�-_ `Xe---_-.------------ Liquid Depth --------•--..._- Capacity-4-; 0 -----_ Typgot _7,0 '°'B-- Materiaa��1P�"1 No. Compartments —------------•--- Distance to nearest. Well _- '- ___Foundation _, �-------------- Prop. Line �•�y LEACHING LINE [i-],No. of Lines _-= _._ Length of each�li e J9 ------ Total Length I- _-r....___.. 'D' Box _� . Type-Filter MoterialAK_�-----Depth -Filter-Material _/F-1� ------•----------------_-- Distance to nearest: Well ------------- Foundation Zo_ �- ^_`'Property Ur1e _-s.______._._.___ SEEPAGE PIT [ ] Depth --------- Diameter ________________ Number -_.____----------__-______Ro&f 11e d Yes ❑ No i❑ Water Table Depth ------------------------------------------------Rock Size --------------------------- DistQnce to nearest, Well -----------------------------------------Foundation -------------------- Prop. Line ---------------------- REPAIR/ADDITION-(Prev.Oanitatiop Permit# -------------.-.-_-.-..-----.:_----: ------------- Date --------------------------•---.---js + SepticTank (Specify Requirements) ------------------- -------------------------------------------------------------•------------------i—- ,..----------------•---------- I Disposal Field (Specify Requ(rements) ------------------------•---------------------------y------------------------_-- - ---------------- --------------- ------------------------- -•---------------------- f ----------- -----------i------------------------ .._fQraw-existing and required additidn 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 Districi. Horne 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, prsoe in such manner as to become subject to Workman's Compensation laws-of-Cc Iifor`nia. .'- _ ._ _ I ] Signed ----------------------- � -- -�7-------------- -- - - I _ -- ---- ---- Owner By: r 6 F �/1 ------------------ -_------------------ Titl (If other than own F FOR DEPARTMENT USE ONLY R APPLICATION ACCEPTED BY t [ - - - ---------- ---- -- - - ------ DATE `�_ ---------- BUILDINGPERMIT ISSUED -- -- -- -- ------------------------ ----------------------------------------- -------- --DATE -..-------------------� ------------- ADDITIONAL COMMENTS ---- - - - - ---------- --- --------- ----- -- -------------------------------- ---------------------------- - -- - ------------------------------ -- -----=--------------------------- - ------------------L------- --------- ------ ---- ---------------- - -------- ------ - - ----------------------------/---------------------------------------------------------------------------- - ---- ----------------------------- - - --- ------------------ --- ---------------------- Q ------------- -- ---1f Final Inspec ----- ----- - -- - - - -- ------------------------------------------Date -------- --- - SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M