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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ` Permit No. [Complete in Triplicate] ---------=----------------------------------------------- # This Permit Expires 1 Year From Date Issued Date Issued _0464X 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 ------------CENSUS TRACT -------------- - ---------- � Owner's Name ------= C�IYLA—e-------------------------------_---------------------------------------Phone ---`------------------------•-•-- Address Q C �Q_ --------------------------------------------i nv-5U . City - --------!E S_Cpa?_n--------------------------------------- Contractor's Name ------ License # _ _ Phone __&�_ --------------- our << ��+ g Installation will serve: Residence Apartment House❑ Commercial ❑Traile� t Q Motel ❑Other ------------------ --- Number of living units:.__- ------ Number of bedrooms __- .._=Garbage Grinder __________ Lot Size ------ _Q___C �rCeS-___-_______ 6 Water Supply: Public System and name ---------------------- ----------------------------------------------------------------------------------------Private Character of soil to a depth of 3 feet: Sand'❑ Silt El Clay ❑ Peat❑ Sandy loam •❑ Clay Loam,E) 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.) N"- NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT Capacity EPYIC TAN _ K f ] Size ___.__1_�'0Q__C __------------ Liquid Depth ------6 --- V { U + p y t- TX Type __fwm+ Material---�YLCft: L No.�Compartments ----rZ............... Distance to nearest: Well ---------1a-- �ans°1 l ---- ---------Fc tion d------------ Prop. Line •-------------- LEACHING LINE [ ] No. of Lines -___4------ -------- Length of each line__ ��.- _��-0.� Total Length s�Z-- 'D' Box --- ------ Type Filter Material _- -----Depth Filter Material --------- _--___________________ Distance to nearest: Well ----4_n_ .......... Foundation _------10---------- Property Line ------ __-_ ------ SEEPAGE PIT j'T— Depth __- ------ Diameter ________________ Number ---------------------------- Rock Filled Yes ❑ No i❑ R Water Table Depth ------------------------------------------------Rock Size ------------------------•------- Distance to nearest: Well ---------------_------------------------Foundation -------------------- Prop. Line -----------.__________ REPAIR/ADDITION(Prev. Sanitation Permit C# ________._____________________________ - bate ------ ) SepticTank (Specify Requirements) ---------------------------------------------------------------------------------- ---------------------------------------------------------- Disposal Field (Specify Requirements) ----------------------• ----------------------------------------------------------------------------------------------------- _______ t (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 bec a sub' ct to Wo kman' Compen tion laws of California. s Signed i/--- - - -- ------ ------- ------------------- I Owner By ------- ---------------------------------------- Title ; ---------------- (If other than owner) FOR .DEPARTMENT USE ONLY APPLICATION ACCEPTED 8 - - ----------- ------------------ DATE ....6_7107.C9- --7-111® .�-` -------------- ---- --------------- --- ----- - BUILDING PERMIT,ISSUED - ------------------- ---}-------------------------- ----------- ----------- DATE r ADDITIONAL COM Ts. -fJQT� LL X1.971-----(3Xe A_V%--- eV ---- - -- -V $ a � _ %AV%- -W ,l tae-_'�i0+----tn^ -----�► a- t►� a_fm!'------------ --------------------------- --------------------------------------------------------------------------------------------------------- -------- ---------------------::----- ----------- - ---- t ----- ----* - inal Inspection by. - --------------------------------------------------------------F _ -------------------------------------------------------- -----Date --- --� SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'b8 Rev. 5M