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FOR OFFICE USE: U APPLICATION FOR SANITATION PERMIT 3 ,f (Complete in Triplicate) Permit No: __`y7=_ C? --------------------_----_-------------------------------- This Permit Expires 1 Year From Date Issued 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 compliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESSAOCATION .--`--------- . -- W- '---- ------c� 1 CENSUS TRACT Owner's Name -- ---- --•----------- ------------------Phone_411---7- -------(---&12- i Address -----------------------C r - ---------------------------------------------•--- City ---------------s -------------------•- ...... � f i Contractor's Name ---CC=_V.-7•_f__f—_t_G_D______-Sl=_ _Q�--------I-N__fi_.License # - - `F.!_r73_ Phone i Installation will serve: Residence Apartment House❑ Commercial :❑Trailer Court Motel.❑Other -------------------------------------------- Number of living units------I----- Number of bedrooms ------I-----Garbage Grinder ------------ Lot Size -----)_ `_X_.__ p_Q__`_____. Water Supply: Public System and name ---------------------------------------------------------------------------------------- ---------------------Private Character of soil to a depth of 3 feet: Sand❑ Silt El Clay ] Peat-.0 Sandy Loam ❑ Clay Loam C Hardpan Adobe`] Fill Material _____.__.___ If es - p ❑ yes, type --- - -------------------- I (Pl'ot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) NEW INSTALLATION: (No septictankor seepage pit permitted if public sewer is available within 200 feet,) r PACKAGE TREATMENT [ ] SEPTIC TANK'[ ] Size__________________________________________ ' ---- Liquid Depth -------------------------- Capacity -------------------- Type -------------------- Material---------------------- No. Compartments Distance to nearest: Well ____________________________________Foundation ---------------------- Prop. Line ___________--:•-.-•--_ LEACHING LINE M No, of Lines ---------1-------------- Length of each line----------&0__'_._.______ Total Length ------s_ MD 'D' Box ----------- Type Filter Material ___Depth Filter Material _______________ Distance to nearest: Well -li-T?'---------- Foundation ----1--p-_----------- Property Line ------5�--'------------- SEEPAGE PIT [ ] Depth ----f--------------- 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 -------------=--------------------} SepticTank (Specify Requirements) -----------------------------------=-------------------------•----- ------------------------ -•--------------------------- Disposal Field (Specify Requirements) ----6-D-P-----------�------07X_1_677 -k------- y `f =''X---------------------------------- i ------------------------------------------------ ------- -------------------------------- ------------------------------------------------------------------------------ I ' ---------------------------------------- --------------- - ------------------------------------------------------------------------------------- --------------------------------------------------------- (Draw existing and required addition on reverse side) I hereby certify that 1 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 ---� 1 /. � -5C _ - - ------------------------------1----- 6------ Owner BY �LY�-t-1 ---- ------ Title -------- --- --------------------------------------------------------- (If other tha owner) FOR VMRTMENT USE ONLY APPLICATION 'ACCEPTED BY _. ------------------------------------------ DATE -------•--------- BUILDING PERMIT ISSUED ------ -- -- ------------------------------------------------------------------------- -------------- ------------------------------------I------ ADDITIONAL COMMENTS -------------f - --------------------- -----------------------------------I------------------------------------------------------------------------------------------- ------------------------------------------------- i: ----------------------------- ---------------------------------I---- --- ---------------------------------------- ---- ------- ---=------- Final Inspection by: -----------------• - ------------------------------------.Date �� - SAN JOAQUIN LOCAL HEALTH DISTRICT t E. H. 9 1-'68 Rev. 5M.