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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT (Complete in Triplicate) Permit No. _1A'�_ This Permit Expires ] Year From Date Issued Date Issued71 "'may 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 .___ _ i- - 'I.= ;�� _ `5 t f 4 r - oD�RTS CENSUS TRACT Owner's Name ------YjFP1L� ---------VF}1�----�-5SEfj--------------------------------- -------------------Phone Address -----�----------M__0_j _ RCity 1 P ! Contractor's Name -----6 --i--F--------6A_R&aL ------------------------------------.License #zY_31�9--- Phone Installation will serve: Residence �rtment House,[] Commercial-❑Trailer Court ',❑ Motel ❑Other -------------------------------------------- Number of living units:---I------- Number of bedrooms 2. _ __.Gorbage Grinder NQ---- Lot Size .-1 _ -R i .-------------- Water Supply: Public System and name -----------------=--------------------------------------------------------------------------------------------Private Character of soil to a depth of 3 feet. Sand'❑ Silt❑ Clay ❑ Peat❑,f/ Sandy Loam Clay Loam ❑ Hardpan 0 Nobe ❑ Fill Material -_N_ __ If yes, type ---------------------------- �J (PI'ot 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 pe'rrfiitfed if public sewer is available within 200 feet,) n PACKAGE TREATMENT\, [ I SEPTIC TANK�[ ] Size------------------------------------------- ----- Liquid Depth -----------_-_--_-------- Capacity -------------------- TYP ------ =---------'` Material--------------------- o. Compartments -------------------_ Distance to nearest: Well ---------------------- ------Foundation ----- ---------------- Prop. Line ----------_---------. p� LEACHING LINE [ ] No,of Lines ---------------------_TLength of 'each 1ine------------------------ Total' Length -------------------------- D' Box - Type Filt M-nterial_ = P f, `� - l De th �ilt'er atena r { Distance`to nearest: Well - :'!-_------_:�------ Foundation - __ ____ Property Line ------------------------ SEEPAGE PIT [ ] Depth ------ --- i --_--__-_ Ria ter _________________ Number ------------------- ------- Rock Filled Yes ❑ No I❑ Water Table Depth --------- -------------------------------�=-..Rack-Size— = -_---- --.:-:-a,- Distance to nearest: Well, -------- ---------------------------------Foundation - --------------- Prop. Line _.--.--..-__--__.--_-_ r REPAIR/ADDITION(Prev, Sanitation Permit --------- _ -------------------------- Date ------_-.---- } --------------- _-_ Septic Tank (Specify Requirements) -___-t-------------------- - "--- - P F (Specify Requirements) APP,ROC-------�------ -"-------- Lj&G�-1- =-------- -�- -/4 B:)7 46 -- -------- WF=k17-------------/00----------4-r_------- `I r`-------LF-:B4 ------ q5--------$U_PP EM- NTS-4------ --—------------------------------------------------------------------------- (Draw existirig and required addition on reverse side) I hereby certify that 1 have prepares! this ,apipliclation 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 n the performan of the work fair which this permit is issued, I shall not employ any person in such manner as to be me s bi o Wor s Compensfa ` laws of California. Signed ---- - ------ ---- --- -----s -------- --------------------- Owner ; ti BY -----------------------------------= _ --------------------- -------' � 'D-------- Title ------------------------ -W-(if other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ___ �__ '_D_ DATE ----- ---------------------------- �_-__ .`_7 _-'__-- - - - ----------- ---------- BUILDING-PERMIT.JSSUED ----------- - ---- ------------- _; - -------------------------- ,--------- ----.------:-------DATE--------------------------------------- ADDITIONAL COMMENTS -- -- - ----------------------=--- =--------------- �------ = - � =� � �3�=�------------ - -.- - - ---------------------------------- ------- -------------------- ------- - ---- ---------------------------------------------------------------------- -- - --------------------------------- --- ---- --- --- - --------- - - ------------------------------------------------------- Final Inspec ' -----------------------------------Date -------- - _ . SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'66 Rev. 5M