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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ------------------------------ --------------- � - _ (Complete in,Triplicate) . . Permit No. ___________________________ This Permit Expires 1 Year From Date Issued Date Issued 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 .x'6°_94___-_, ,fZlu ---- ------CENSUS TRACT -------------------------- Owner's Name /v]Fl_ .: ----- ----5------------------------------------------v Phone ------------------------------------ f ! - - - Address ---2_oo 9(.11-- ----A`-------- -----I V f?-----1 -------- ------------ City / O IV Contractor's Name --------"V _-_Ct_____� __ 1_� ______________________________License # Phone Z-93_=L.�? � Installation will serve: Residence V Apartment House�❑-Commercial OTrailer Court i❑ - Motel ❑Other " � r�_Number of living units:_____'____:: ------------------------- -----Number of bedrooms ��Garbage Grinder _ ___ Lot Size __ _ __ ___ _ __�erf4_�_�________ Water Supply: Public System and name ----------------------------------- -------------------------------------------------------------------------Private Character of soil to a depth of 3 feet: Sand'V Silt❑ Clay-F1 Peat❑ Sandy Loam ,E] Clay Loam :❑ Hardpan ❑ Adobe ❑ Fill Material �If yes, type ---------------------------- (Plot _______ ___________________(Plot plan, showing size of lot, location of system in relation to wells, buildings, etc, must be placed on reverse side.) 6 NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,] N PACKAGE TREATMENT [ ] SEPTIC TANK [ ] Size,____ __ ____ Liquid Depth _____________________,-.._- >, o Capacity-.•_- ---- TYpe -------------------- Material---------------------- No. Compartments ---------------------- Distance to nearest: Well ------------------------------------Foundation ---------------------- Prop. Line -------------__........ LEACHING LINE [ ] No. of Lines-'--------f_----------,_ Length of each line_________1-0-6-------- Total Length-____1_ Q......._.__ 'D' Box ------------ __l� .______ Type Filter7lMaterial Q_0k.Depth Filter M�teriai ____-__ _______._____ --- Distance to nearest.�Well __ ____cg__ _r___ Foundation _____ - __________ Property Line, ___S�7________ ________ _ J 4 r SEEPAGE PIT [ ] Depth --------- _____ Diameter ________________ Number ---------------------------- Rock Filled Yes ❑ No i❑ Water Table-Depth_ ---------------- -------------------------- -------------------------------- __-_Rock Size -=- Distance to nearest: Well ---- ------;-----------------------------Foundation __________________ Prop. Line ______________________ REPAIR/ADDITION(Prev. Sanitation Permit# -----------------_------------------------ Date ----------------_-------------_.--1 ` Septic Taiik.(Specify,.Requirements) ------------- ----------------------------------------------------------:---------------- - -------------------- Disposal Field (Specify Requirements) A ---------------------- ----------5. /;SL//✓ ----------- c '! /Y1-------------- -------------------------- ----------------------------------------------------------------------------------------------------- (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 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 - -------- Owner 4 BY --- --- -' -- -- -- ------ -- - -------------* ifie -------------------------------------------------------- (If other than owner) `'"�m FOR DEPARTMENL USE ONLY APPLICATION ACCEPTED BY f,� 1 �`' DATEaL�-------------- BUILDING PERMIT ISSUED ---------------------- - --------------- -- ---` �----------------------------------------------------DATE ------------------------------------------- ADDITIONALCOMM T --- -- - -- - -- - - - r------------------------------------------------ ---------- ----------------------------- ------- -}-A,6 -- ------- --------- ---------------------------------- - ---------------------------------------------------------------- --------------------------------------------------------------------------------------- - J " - ------------------ Final Inspection by:. : Date SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M "