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' FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT � ......... •-•- 7 'Sly ` (Complete In Triplicate( Permit No. ...............•---y ..._..--..............•---.._.............. Date Issued ..--••----•-----------.•................................. This Permit Expires 1 Year Orom 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 �. . VA 33 Jog ADDRESS/LOCATION ... ...................................CtNSUS TRACT ......_......... ......... Owner's Name ..................................... Phone &'3s- s'`/8,9 .............. Address SH M f' ��s ,�1,6 n+�e City VeYNAL, /,-5, ._._........_............. �?i------ f-..._.. ...-----...__.._._-_..__......_-- ..................................•....-.....................I.----...... Contractor's Name u r + ca c ✓a v License �.6..-_5-:?( ._. Phone ..� � 3 ..V 2.J Installation will serve: Residence 0 Apartment House 0 Commercial ❑Trailer Court CJ Motel ❑Other --•---•--•------------------------------•-•- A Acres Number of living units:-..--/------ Number of bedrooms ....1.......Garbage Grinder ............ Lot Size ............................................ Water Supply: Public System and name ..._....................---.--.-----------------............................Private Pq Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat[3 Sandy Loam 0 Clay Loam ❑ Hardpan[] Adobe❑ Fill Materia# ............if yes,type ............... ............ W (Plot plan, showing sire 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 .......................... Capacity ---- --------------- Type -------------------- Material.....-----------..:... No. Compartments .................... .- Distance to nearest: Well ....................................Foundation ...................... Prop. Line ...................... LEACHING LINE [ ] No. of Lines length of each line............................ Total Length V Box _ Type Filter Material ....................Depth Filter Material ........................ .................... Distance to nearest: Well ------------------------ Foundation ........................ Property Line ........................ SEEPAGE PIT [ ) Depth -----------------_ Diameter ._..._.. ....... Number ............................ stock Filled Yes ❑ No ❑ Water Table Depth ..........................................__Rock Size Distance to nearest: Well ................... Foundation .................... Prop. Line ...................... REPAIR/ADDITION.(Prev. Sanitation Permit# -------------------------------------------- Date ..................... Septic Tank (Specify Requirements) ----------------------- s fl�r1''T7o�rr.� /v 3 6 ' ...__....... ..................._ ................. Disposal Field (Specify Requirements) ..-._w�`�.��' a_1V.......C-X i � rr`C l ABY ---------------------- -- ---- --- ------- - - - - ----- - -- `'11 IDraw existing and required addition on reverse sideI 1 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, 1 shall not employ any person In such manner as to become subject to Workman's Compensation laws of California." Signed -------- i--- - ---- •------------------=-------------- ------------- Owner BY ------- - -- ---.-.-----.:---------•-- •--------------------- Title -_--------- --•--- .............-. .......... (if other t FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ------------------------•---•---- .............._.-........ .................. DATE ... ._4�..T .._... BUILDING PERMIT ISSUED ----------•-- ........ ..... .....-DATE ....... ..................... ........ ADDITIONALCOMMENTS ----- -•-------------------- ----- - ------------------ ........................................ ----------------------- ----------------- ---....----------•-•-----------------------------------------------------.......... --------•---- ---------•_------------------------------------------- -•-------------•------...,._ P Y: -•---------------- •' - Date ... ��.. Final Inspection b _........-•.... ................................... .......... . .... . . . . 13 2 ]� SAN JOAQUIN LOCAL HEALTH DISTRICT 8/74 3M