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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT' j" --- -'---- - " (Complete in Triplicate) Permit --------- ------------ - --- ------------- . _ _ _ _ _ This Permit Expires ]Year From Date Issued Date issued ------------------ Application 7"-----_---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/LOCATION.. pp .--------P---,0'4L----------%Ue--------------------------- CENSUS TRACT -------------------------- Owner's Name -----------------------------------------------------------------------------------------Phone,. /ry 06/ ------------ Address ----------01V-=-------- FIWA�__51"------------------------------------ --•--. City --- sl_ `Q.�v/r-/nP2 --------------------------------- Contractor's NameS,�T1�fcew`---------------------- License # Phone Installation will will serve: Residence 0 Apartment House f] Commercial ❑Trailer Court i❑ i Motel ❑ Other --------------------------------- ---------- Number of living units:.-./... ..-_ Number of bedrooms __...__Garbage Grinder _1V0 ---- Lot Size e uC'2(---- 1..3.Q..r .............. 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.0 Hardpan ❑ Adobe 0 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.) REPAIR DDITION NEW INSTALLATION: (Noihseptic tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ 3 SEPTIC TANK I ) Size ----------------------------------- ------------- Liquid Depth ---------------- ---------- Capacity ----------- -------- Type -------------------- Material------------- -------- No. Compartments ----------------_--_ V LEACHING LINE [) Distance to nearest: Well -----------------Foundation ---.------------------ No."of Lines ------------------------ Length of each line ---------------------------- Prop. Line -__..--..._-___.._..__ Total Length _....._-----.__...-._..-._.. 'D' Box ------------ Type Filter. Material --------------------Depth Filter Material ----------------------_.-----------------_._ { Distance to nearest: Well ------------------------ Foundation ------------------------ Property Line _---.._..-..-.__._-:.... SEEPAGE PIT [ } Depth -------------------- Diameter ---------------- Number ---------------------------- Rock Filled Yes ❑ No 0 Water Table Depth ---------- -- _-------Rock Size -------------------------------- 11 Distance to nearest: Well----------------------------------------Foundation-------------------- Prop. Line ---------------------- --------------------- REPAIR/ADDITION (Prev. Sanitation Permit # ---------------- ------------------------------------------- Date ------------------------- Septic .._._.----------__.- -Septic Tank (Specify Requirements)--------------------------------------------------------------------------------------------- _----------------------------- C1Cf- �__-.�F � .DisPsal Field (Specify Requirements) ---- -r ..............f---- ---------------------------------------------------------------------------------------------------------------- -.._ ----------------------------------------------------------------------------------------------------------------------------- --------------------------------•------------------------- ---------------- - --------------- ---------------------------------------------------------------------------------------------------------- ii (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 certifiesi 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 . an's Compensation laws of California." Signed Owner as t0 ecome ;�J keit t0 iNor' 9 {7/SC/ BY------- - --- -------------------------'I------------------------------------- ----------------------- Title -------------- --------------------------------------------------- (if other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ....�tv----`�----��----------------------------------------------------------------- DATE _. .l L�.I -a i ----------------- BUILDING PERMIT ISSUED--------------------------------------------------------------------DATE ------------------------------------------- ADDITIONAL COMMENTS 1 � 7-- `� _' rf�z °��' A�`i= - = ---------------- ---------------------------------------------------- --------------------------- -------------------------------------------------------- -.--------------------------------------------------------------------------------------- ------------------------------------- ----------------------------- --------------------------------------------------------------------------------- i -----------------------------f-- ---- - --- ------------------------------------------------------------------------------------ 7j - Final Inspection --Y� --�---- - ------------------------------------------------------------------------------.Date ------ Z --a--- .--- -- a-`- -- -/ S JOAQUIN LOCAL HEALTH DISTRICT ii E. H. 9 1-'68 Rev. 5M.