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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ----------------------------------- ------ -------- Permit No. _ __-_ n r -7- {Complete in Triplicate} ' Date Issued ��__ -�� - ------ This Permit Expires 1 Year From Date Issued 3 Application is hereby made to the San Joaquin Local Health District for a permit to const►uctPnpd install t e work herein described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION _A�__rl� s---------- L[.1. -------CENSUS TRACT --------V/_______________ Owner's Name —------------------------------------------------------- -------Phone-----------------------------.----•-- ` Address a -� �.fJ -I } c-�h Cit �e p Y Contractor's Name ------1-I ._._______[J ,_ --------License # 1�z._frA-V;2__-- Phone t Installation will serve: Residence [5-j<artment House^❑ Commercial :❑Trailer Court 10 Mote! ❑ Other -------- ----------------------------------- Number --- ---- ----------------------- Number of living units:-------1--- Number of bedrooms -3-------Garbage Grinder +a --_ Lot Size Ar"e-11-:4, �.. _- ___.______.__.��, ic Chatreacter Supply:of sop tolSystem a depth of 3 feet meSand'❑ Silt ❑ Clay E] Peat E) Sandy Loam ❑ Clay Loamri�to Hardpan ❑ Adobe V 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 seepage pit permitted if public'sewer is available within 200 feet,) PACKAGE TREATMENT { ] SEPTIC TANK'./ se__..• __ _ Li ,..4 [ } ---- � ------ ----------- quid Depth .��/�----------- Capacity __.�_Z ,_. TypeA41d____�.1' lVlaterial7�Ci- No. Compartments ------------- �- Distance to nearest;_Well .__ --.___________ ___ oundation _ 1 _____y_ Prop. Line _ � ........... LEACHING LINE No. of Lines -- --------------- _Length -of l ' lTotal Len thr,t -----_ .__.._-__ 'D' Box QS_ Type Filter Material I/i ___ _ e__- pth Filter Material ____/- _______________________________ Distance/ to nearest: Well ' f Foundation _-�d_!__________ Property Line --- _._______. l SEEPAGE PIT Depth .__-__- Diameter � Number - �----- - --- - RoLck Filled Yes -`Noli4vw , Water Table Depth --- +� ' Rack Size `L` ------------ o. C Distance to nearest: Well -_--Vq7__,------------------Foundation -.fP-;'_----,--Prop. Line `_ M 6 REPAIR/ADDITION(Prev. Sanitation Permit# _.-------___________________________________ Date _______________ __,_ _____) r t Septic Tank (Specify Requirements) ----------------------------- -------- -----------------,,.--------;-------------- Disposal Field (Specify Requirements) ----------- - -------------------------------------------- -------- s ----�------------ ---------------------------------------f --------------------------------------------------------- i I ; f -------------------------------- ----- -------------- -------------------------------------------------------- -- -- -------- --------- ----:------------------------------•-------------•- (Drow existing and required addition on reverse side) I hereby certify that I have preparedthis application and that the work will be done in accordance with Scan`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 became subject-to-Workman's Compensation laws of California." Signed ------- Owner 6 * L•,. { ---�----------------------------------------------------- Yl (�t.ci -- --------- Title __ W;1,�.. B - i Ikoer_thon owner) " FOR DEPARTMENT USE ONLY 1 f I �APPLICATION ACCEPTED BY ___ - --------------------------------------------------------------------- r :;BUILDING PERMIT ISSUED _.__. DATE _________________ DAT -- --------------------•------------------ AD[aITIONAL COMMENTS - f -------------- - - --- - ---------------- ---------------- --•--1 A E ,- -- ---------- ------=-=--------------------------------f--------------------------------------------- -------------------------------------------------------- ------------------------------- - # - ---- - t Final Inspection by: ------ --------------------- ----------------------------------- -------------------------------Date ---�r-�--7�--�- ------ 4-- SAN --- 4-- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M