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FOR OFFICE USE: 1 _w APPLICATION FOR SANITATION PERMIT (Complete in Triplicate) Permit No. .__��=_`.... ----------------------------------------------- __________ This Permit Expires 1 Year From Date Issued Date Issued `(D. Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This application i made in compliance with County Ordinance No. 549 and existing Rules and Regulations: l bC�© � t�+1 ry �cnr p C¢ '' lily Slovc�h 6-C 5.3 R W ei' JOB ADDRESS/LOCATION _ 10'S r4" -KL___TiSi-r_---------5/9- �tC�!6YltC'----- 1-------------CENSUS TRACT --------- ----------- Owner's Name --------Joovv%e_�--------P? '----S e- ---------------------------- -----------�-- ----Phone Address -------401(U---------LLI � -- ` city �7T1 �'P R-- --- - - . Contractor's Name -------- ---5a ------------------- -----.License # ------------------------ Phone ---5ct ......-- Installation will serve: Residence Apartment House❑ Commercial ❑Trailer Court Motel ❑Other ------------------------•------------------- Number of living units-----I------- Number of bedrooms _ 2-.____Garbage Grinder _W __ Lot Size -------Iba---CXCTe__S------------- Water Supply: Public System and name -----------------------------------_---------------------------------------------------------------- ---------Private p 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.) d NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT Ca aci Liquid Depth __________________________ C I SEPTIC TANK{ l Size--------------------------------------------- -- p ty SooC�-- Type -_______ No. Compartments T e ��- Material-------------- -----;�"-------•=---- i tDistance to nearest: Well -------------�D� _ _ _ Foundation ______a___________ Prop. Line _.-.___.__..�......- LEACHING tMX [ I No. of Lines ----------------------- Length of each line---------3-Q�--------- Total Length ----- (64........... }le_)k 'D' Box -----t------ Type Filter Material ______Depth Filter Material _________I ---------------------________ �- Distance to nearest: Well -----------------------—Foundation ------ ---------- Property Line ------------ ...... ' SEEPAGE PIT [ ] Depth ___________________ Diameter ---------------- Number ---------------------------- Rock Filled Yes ❑ No ❑ fl Water Table Depth --------------------------------------- --------Rock Size --- --------------------- ----- Distance to nearest: Well _____ _____--Foundation -------------------- Prop. Line ...................... REPAIR/ADDITION(Prev. Sanitation Permit# _____ -_ _S _________________ Date ....) C"tce-fei SepticTank (Specify Requirements) ------------------------------------------------------------------------------ ---------------------------------------- ............ Disposal Field (Specify Requirements) -------- 7------------- ----- ---- ------------- 11 ------------------------------------- --------------- ------------------------------3— -'-- - --------------- SbQ . .... ------ i �9- n �(`6 -c . 1, ` -tuts ----------�Zerse------ -� � d (Draw existing and re4dired addition on 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 th he performance of the work for which this permit is issued, i shall not employ any person ir��such manner g to e me su ject to Workman' mpensa ' �ws of California." Sig ned -- --- -- -- ---- -- --- ------ - --- ---------- -- Owner By --------- ---------------------------------------- --------------------------------------- Title ---------------- (If other than owner) FOR D RTMENT USE ONLY APPLICATION ACCEPTED BY ----- --- OMS t------ - ----_. DATE S`-_2 ----------- BUILDING PERMIT ISSUED . - --------------DATE ------------------- - ADDITI NAL C MM NTS -----__ ________ _ - - --- -- ------ -Post (3 VX r)0n kvi u. �. � + ----------------- ----------- • - - -- - -------------- ------------- ---- ------------ ----------- -- - -- --- --- - --- ----- ? ----- Final Inspection by: -- ----------------------------------------------------------------.Date -----P-�-2�---"'� -- SAN JOAQUIN LOCAL HEALTH DISTRICT l E. H. 9 1-'68 Rev. 5M r