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FOR OEFICF_U&,E: j APPLICATION FOR SANITATION PERMIT VC Permit No. ? - -I (Complete in Triplicate) -- ---------- ------- -------------------------------------- Date 'Issued This Permit Expires 1 Year From Date Issued Issued _-✓�.-_-___L___Z_z/ 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 -------- ��f .5� 1' '- ------- = ----- ---- -------CENSUS TRACT -------------- -------- Owner`s Name -��.b ``--------- /tL 1�-14-- -------------------•----------------- �, Phone Address .--- -f-s576 4-/-------- ------------- City, 1/� `� ------------------- _9 ------ - Contractor's Name --- ---1 ----- 5,l ---------------------------------------License # 7. �------- Phone- - Installation will serve: Residence [KApartment House,[:] Commercial ❑Trailer Court ',❑ Motel ❑Other --------------------------------------------+ Number of living units:------ Number of bedrooms __-----Garbage Grinder ________- Lot Size __ _ __ / __._____-__- Water Supply: Public System and name __! _l _ ►__� f_ ------nv--, J ---------_---------------Private ❑ Character of soil to a depth of 3 feet: Sand'o Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ Hardpan ❑ Adobe ❑ 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:[ ] Size__________________________ _ ________ __ Liquid Depth _____._.______--____.._- 1/1! Capacity -------------------- Type --------------- Material- ------ -------- -- No. Compartments -------------•-------- Distance to nearest: Well ----------------- -------------- -------------- ----Fou dation ---------------------- Prop. Line ____-_____-----_-_--__ LEACHING LINE [ ] No. of Lines ------------------------ Lengt of ea, line--- ----------------------- Total Length --------------_----------- 'D' Box ------------ Type Filter Mat ial ----------_-------- epth Filter Material -------------------------------------------- Distance to nearest: Well _______ _______________ Found ion ____________________ Property Line ____________._____._.___ SEEPAGE PIT [ ] Depth __.__.____.________ Diamet ___________.___ Num er _________________________ Rock Filled Yes 0 No i❑ Water Table Depth ----------- ---------------------- ------- - -Rock Size ------------------------------- Distance to nearest: Well __________________________________ __•_Foundation ____-___--._- ------ Prop. Line ------- -------------- REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date ---------------------------------- Septic _______-___________.___________-Septic Tank (Specify Requirements) ------------------------ o---------------j------------------------------------- Disposal Field (Specify Requirements) ___ ________. _/� �1 ___� d_____7_'),-___f;z -----—,75 I'X r__A4-P,-_e --._:� Q --------------------------------------------------------------------------------------------------------------------------------------------------------- ------------------------ ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- (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 --- -- ----- --- - -/�han �owner --------------------- -------- - Owner --------------------- By ----- ------ ----- �� Title . = ------------------ ---------------------------------- _(11 --------------------------------- (If oder ] FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY -------- -------- --------------- DATE ----.- —�y—/"� ---------------------------------------- BUILDING PERMIT ISSUED --------------- ----- ------------------------------------ -----------------------------------------------DATE -------------•----------------------------- ADDITIONALCOMMENTS --------------------------------------------------------------------------------------------------------------------- ------------ --------------------------- ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- -------------------------------------------------- Cfn -------------------------------------------------------- ------------ Final Inspection by: = ----------Date ----�y =�f SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rey. 5M