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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT , - �� --•-�- -. ��_�;,,. Permit No. ��- Fx N (Complete in Triplicate) ! r Date Issued --- -This ---This Permit Expires 1 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 described. This application is made in compliynce with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION - ---------- -----------------A-eAye ------------ --------------' CENSUS TRACT -------- -----=---------- / ---------Phone ------- Owner's Name ------ —A3;1 A3;11------ -� 7"�S'-------------------------------------------------------- .d?2 ---------------------------------------------------- Cityl" o_E- 0 6 Address _ _.- - "] _ �- "! +� fptoe Q,-r ' --------.License # _:- Q Phone Contractor's Name ._.."- � ..�•-�- --^�' � ��- ---- - -- - Installation will serve: Residence 50partment House ❑ Commercial []Trailer Court ',❑ '- . .0 1 Motel.[:] Other _.-` _ `'"" -( o Number of living units:---""-.f_._ Number obedrooms ___ --_ " G g Grinder ------------- Lot S,'. a ------ --------------------------------- ---------- -------------------------..-----. ^� Water Supply: Public System and name 4nd [F Private ❑Character of soil to a depth of 3 feet: r 5Silt ❑ Clay' ❑Y Peat ❑ Sandy Loam ❑ Clay Loam ❑ Hardpan ❑ Adobe,F Fill Material ----------I_ If yes,type -------------------------- - (Plot plan, showing size of lot, location of system in .relation ta.wells, buildings, etc. must be placed on reverse side.} NEW INSTALLATION: (No septic tank or seepage pitipermitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK![ ] Size------------------------------------------------ Liquid Depth .------------------------- G Capacity Type ----------------- Material-------- ------------- No. Compartments --------- (I Distance to nearest:.Well-------------------------------------Foundation.---------------,------- Prop. Line ----------------.----- LEACHING LINE [ ] No. of Lines ------------------------ Length of each line---------------------------- Total Length _---.-----:.---"-_. ------.- 'D' Box ------------ Type Filter Material --------------------Depth Filter Material --------------------=----------------------- Distance --------• - ---------- Distance to nearest: Well ------------------------ Foundation ------------------------ Property Line ------------------------ SEEPAGE PIT [ ] Depth -------------------- Diameter ---------------- Number ----------------------'------ Rock Filled Yes No .0 WaterTable Depth ------------ -----------------------------------Rock Size ----------------------- -------- Distance to nearest: Well ----------------------------------------Foundation -------------------- Prop. Line ---------------.------ REPAIR/ADDITION[Prev. Sanitation Permit# --------------------------------- ---------- Date ---------------------------------- Septic ----------- -----Septic Tank (Specify Requirements) ".--__-_ ---" - - --------- 9 V D' posal Fie�J (Specify Requirements} `�=i'f4"~ ' �---- A,"� 4 a1Utz,--------------- ------ ----- ----- - --------I------------------------------------------ -------------------------------------------- (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 "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 b subject to Workman's ompensatio laws of California." Signe - - ----------------- By --------------- - --------- Title ------- - ----------------- ------------------- - --------------------- (If other than owner) FOR DEPAR MENT USE ONLY APPLICATION ACCEPTED BY --------- -------------- -------------------------- -- ----------------------------- ------------------- DATE ------- - / 6---------------- - --------- BUILDING PERMIT ISSUED ------------------- ---------------------DATE -----------------" ----------------------- ADDITIONALCOMMENTS ---------------------------- ------ ---------------- --------------------------------- --- ------ ---------------------------------------------- ------------------------- ------- ------------------------------------- --- -------- - Date - Final Inspection.by: .---- -- -'- ---•--av�----------------- -------------------�-------- - SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M