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jrCf[2 OFFICE USE: ; AL F_-� i r y APPLICATION FOR SANITATION PERMIT ' e-- -- Permit No. - I(Completein Triplicate) f + �. ---------- --------------- b_-------------- i,��._-�,..., u xk• _., Date Issued . � -------------------------------------- This Permit Expires 1 Year From Date Issued Applicati01n*1is1liereby 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-ReguGfionsr JOB ADDRESS/LOCATION _--SS I Z_ /V�aQ --------------------- ---------- ...I-D---------------- CENSUS TRACT,-------------------------- A,� Owner's Name ----=�---.. »� w �.t =___.Phone 9:3J�_"._?t10---•-------- ,� Address ----- S Z-1-/l)-Da-----c�-- -.-'E5--- a -== Cit �r# . Contractors Name AY-- ��?`.l T'-- + --- Sf t4L _--:License # 34 ------ Phone''-'G6.-3$¢1-----. Installation will serve: Residence*A�Apartment House-F] Commer-ial` Tcdiler lvourt-❑. •- -� "�, p i, Motel ❑Other ------------------------------------ti - _ I . J Number of living units:---- ------- Number of bedrooms =_Z_ --__Garbage Grintder �=�_ Lot Size ______________ -_-j------..------ WaterSupply: Public System and name ------------- ------ -- a "-------------------------Private t 4L_ I (.1 Character of soil to a Apth of 3 feet: Sand'El Silt[I Clay El Peat Q Sd"ndy Loam •❑ Clay Loam ❑ t Hardpan ❑ Adobe Fill Material 1,If yes;type --------- -- `,n (Plo plan, showing sizeuof'lot,"location'of'system in relation to'wells, buildngs, etc, must be placed onreverse side.) I` NEW INSTALLATION: (No septic tank or seepage pit,permitted.if-public'sewe s available within 200 feet,) fn, ' i PACKAGE TREATMENT [ ] SEPTIC TANK'[ Size--------------------- '------------ ----�;--- ----is - --_,------ ---- Liquid Depth------------------------- � t ,- I Capacity Type 'R Material__ -�:[ No.� Compartments ---- r -------- Distance to nearest: Well ----------------- ----=---- 'Foundation -- ------------------ Prop. Line -------------- -----LEACHING ------:-------'-`-'BLEACHING LINE—[ • ,i ...,. --, .. - w [ ]-1\16-6f L ne--s ----- ----------- -- Length of each line--------------.------- Tdta! Length --.. _ ......... 'D' Box ---- Type�Filter Material -----------Depth- Filter Material --------------- --- ._...._...--• -_-- Distance to nearest: Well ------------------------ Foundation ------------------------ Property Line ------------------------ 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 -------------------._.._.-._._-...) Septic Tank (Specify Requirements) -------------------------------------- ---------------------------- ------------------_---- ----- Disposalfield iiSpe!ify Require�ents} _±�Dd_--� � ---- .�. T11J.-c------s - �� -- � �----�7©---- : ----��.1?�--- --- - ------mc--(l)- A8 --- ----- i N -----P ir---------------------------------- (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 BY ------ ----------------------- --------------- -------------------------------------------------- - ------- - -------- ----------------------------------------- Title ...-.1`''I_ - ------ ----------------- (If other than owner) FOR DEPARTMEN USE ONLY '74 APPLICATION ACCEPTED BY -- --- ---------7_2Q`'Zyf��° ----------------------------- -- -. DATE -------�--J---eTf 66 BUILDING PERMIT ISSUED ------------------- ------DATE ------------------------------------------- ADDITIONAL ------------------------------.----- ---ADDITIONAL COMMENTS ------- ---------------------------- ------------------------------- ------------------------------- ---------- ----- - ----- - ---•-----------•-----------------------.-•- •------- ---------------- - - - ------------------------------- ------------ - -- ---- DateFina! Ins ectian bYf - i SAN JOA IN LOCAL HEALTH DISTRICT f E. H. 9 1-'68 Rev. 5M. i