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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ry Permit Na. ��?-'7=�-•�_ t - (Complete in Triplicate) ------------------ ------ -------------- AO--- -- Date issued - �� " ------ --------- -- This Permit Expires 7 Year From Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein liance with County Ordinance No. 549 and existing Rules and Regulations: described. This application is made in comp JOB ADRR�SS-, O11, TION ..-_1- -----�------6_anrT�------Ff", - -•---------------CENSUS TRACT ---��__--- ------ Owner's Name ; � .I 'C1\ - 1- _ - _ - -Phone --------------------------• ------ scA-c ,.�' ------------ Address ---- -- t�).,j`��`r-Tf�------��_--------- -•--. City ---- - ----- - hone Contractor's Name -------- ' License # ------------------------- -- P Installation will serve: - Residence��partmentHouse°❑ Commercial :[]Trailer Court 0 r Motel Fj' Other -- - Number of livi!W_units:---.-�. 4` Number of bedrooms _ Garbage Grinder --__-- Lot Size -.:'_- C Water Supply: Public System ar'd name -----= ,` ]:' - - - Private Character of soil to a depth of 3 feet: Sand' Silt❑ Clays❑ Peat E3 Sandy Loam ❑ Clay L'ot�m;❑ �*R ,r Hardpan ❑ Adobe ❑ Fill'fUlaterial --A-Q-'- If,yes,type (Piot 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 pu61l'csewer is available within 200 feet,) \ i PACKAGE TREATMENT [ ] SEPTIC TANK'[ ] --- -� Size-------------- ---'=--------- Liquid Depth -----_- �Q Capacity -- Type ------------------ Material__,;-----,----------- No. Compartments -------__------------ �:� 1] :___Distun ce._fio_'nearest: Well<,ti-------------------- ------ ------------ -Foundation -------- ------------ Prop. Line ---------•------ i -------- LEACHING LINE [ ]' No of Lines _,-_;--- -------------- Length of each line--------'_,-----_--------- Total Length -------------------- s, � I De th F -'Material --------- 1 Type Filter Material!---:- - P ! Distance to nearest: Well --------------tie�1- Foundation --____e_``------------- Property Line --------- --------------- i -------------- �t---\Number- _------ -------- --------- Rock Filled Yes [] No �Q SEEPAGE PIT ' [ ] � � Depth _-- Diameter -----____- Water _ ► A\---�` =--•-Rock Size ------ -' --------------•------- I epth -------------- � Water�Tdble D�� .s Distance to nearest: Well ----'`-----------------------------------Foundation Prop. Line -----------•--.------- T. 2 REPAIR/ADDITION(Prev. Sanitation Permit# ------...---':----------------- -------- Date -------------------------;--------1 Septic Tank (Specify Requirements) ------------------------ -----------------------':`'�0�' C ---------------- ------------- ----------- Disposal Field [Specify Requirements) -- (5 �� ,' f; �1f - I1�- __C•�� - �0 -------- -I--� M---------`fit-G-H-`1�--- " `- t�� J- :r -P1 . { lf s i ..iX_.� ---------------------------------------------------------------- ` j [Draw existing and required addition%qp reverse side) I hereby certify�th st 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 si na ure certifies the following: - "I certify ih in the performance. work for whit this permit is issu I sh�+511 not employ any person in such manner as to bec eisuh;ect to Workman' C mpensation la lifornia." �- x.7 E Sign d ' - ------- --------- Owner_ i --------------- _ Title 't----------------------- -------------------------- (If other than owner) -FOR. DEPA1tTMENT USE-ONLY O APPLICATION ACCEPTED BY ------ --t`-�"�'"-'-��=--------`---------�--=�`�,,•��-------------. DATE ------- - �-25------7--- ---- BUILDING-PERMiT-ISSUED" ,.: _ .� �::_. ` ' = - ' ``-_=� =__ --------- - ` - =-T DATE:� ==:_'= =-_.__--:- ADDITIONAL COMMENTS--l- ----------------------------------- ------------------------ -------------------------------- --------------- ------------------- ----- ----------------------------------- ---- - --- -- ---- - --------------------------- ... ---------------------- -- --- -- -- -- --- -- --- ---Date ---- Final Inspection-by -. SAN JOAQUIN LOCAL HEALTH DISTRICT I E. H. 9 1-'68 Rev. 5M