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FOR OFFICE USE: ft •� — 7 '0 APPLICATION..FOR SANITATION PERMIT",— , t `f.l. .__711---------------1 f y 41 -1 e `r ; "'i e r � Permit No: SCJ_�5 el- (Complete in Triplicate) ------------ This.Permit Ex fres 1 Year From Doto,Issued" s` Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the `work herein desp ibe . Thies.application is made in compliance with County Ordinance No 9 an eRi 'n Rule and Regulations: air !C,10 A +�l, / , ' JO ADDRESS/LOCATION 1; t t f3t �CP�hSI T CT _ Owner's Name ----- --- -Phone s !Y7z-ay _ Address Q / f ---- ------- 'y--J-------- -- ---- •-- City , - �` ------------------------ Contractor's - -- --- Q �• Contractor's Name --------- --- ---t---------W-------------- - ( 1 --------------License #l� _�.�------- Phone - --- --------------------•-- Installation will serve: Residence ❑ Apartment House❑ Comm ercialXTra1ler Court ;❑ ! Motel F-1 Other --------------- Number of living units:------:___- Number of bedrooms ------------Garbage Grinder ------------ Lot Size --------------------------------______---- t --... t Water Supply: Public System and name ------------------------------------ -------------------------•------------------------------------------Private Character of soil to a depth of 3 feet: Sand'❑ Silt-F] Clay ❑ Peat Sandy Loam ❑ Clay Loam :❑ ` y` HardpanKA fE],., , Adobe • •;Fiil_l Material ------------ If yes,type---------------------------- F (Plot plan, showing size of lot, location of sysf min reIafIbnjto5 wells, buildings, etc, must be placed on reverse side.) + NEW INSTALLATION: fNo septic-tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK'[ ] �CJASizefee- --------------------•------- ---- Liquid Depth ----------------••----- I Capacityr`4= = Type -------------------- Material---------------------- No. Compartments -------------_--_- { � �j�fDVistance,xo ,ne rest: Well -----_-----'---------------------------Foundation ----_--;-------------- Prop. Line -------•--------•----- ` �' ---- Le gtFro, each line--------------------------. Total Length --------------------_----- LEACHING LINE s t_ _ �" ________ Type Filter Material ----------------Depth Filter Material -------------------------.__-___-_---_-_-_._ I 4 f i 3 Distance to nearest: Well __�----------------- Foundation ------------------ ----- Property: Line ----------............ .- 4 ii SEEPAGE PIT [ j Depth.L4_---- -------------! Diameter Number ----_.-.- ----------------- Rock Filled Yes ❑ No 0 j Water Table Depth - ' ---------- --- -- --------------•---=--------Rack Size ------------------------------ ------------------------------- ---------------------•------- ,. 4 p Dista�c_e' fo nearest: Well --- -------------------------_--__Foundation Pro . Line _.,.....__.----------- REPAIR/ADDITION _:_- _REPAIR/ADDITION(Prev. Sanitation Permit# ----------- ---------------------------- Date -----_--_-_----_--___--__-_____-__J Septic Tank (Specify Requirements) -------- ---------- -------------------------- ------ -------------------I---------------------------- Disposal ------Disposal Field (Specify Requirements) ------- -- --- --- ccs- i4_.�,.. - -.�..,.....,��..., ------------------------------------------------------------------------------------------------------------------------------------------------ �'� { (Draw existingand required addition on reverse side) -------------4 --------------------------- 4 1 hereby certify that 'I have prepaied-this applicaJtion 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 as to become subject to Workman's Compensation laws of California." Signed ------------------- t ` f Owner . ------ -------------- ---------------------------'] Title b By --------- ---- -- --------- i (If oth han owner) --Fog,DEPARTMENT USE ONLY //,,�� APPLICATION ACCEPTED BY --------..Lrif ---- --- ------- ---------------------------------------------- DATE -�T_•`7v - BUILDING PERMIT ISSUED -------------------------- ------------------;--------------DATE ------------ --------------------- -------- ADDITIONAL COMMENTS ��---------------------------------------------------------------------------------------------=--------------------------- ------------------------------------------ --------------------•---------- ----------------------------------------------------- --------------------------------------------------------------- -------------------------------------------------------------------------------------------------------------------- ------------------ --------------------------------------/------� - - -- --------------------------------------------------------------------------!v -------- - - --------------- Final Inspection by ---,!: . ---- ----------------------------------------------------------.Date T_-l�'------v--------------- SAN JOAQUIN, LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M