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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT --------------------------------------------------------- Permit No. ---' _y (Complete in Triplicate) --------------------------------_------------------------ Thi,, Permit Expires 1 Year From Date Issued Date Issued ---- 1 Application is,hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This as ication is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION -----------`-- " � - -------------- - ------CENSUS TRACT ----- --.- Owner's Name -- ��I i -- !�-L1 PS---� l-SI-S� --`- Q •----------- -------Phone 5_Sr3_-__— L1.. Address Contractor's Name ---P 1 ------<_'O.._'-----------------------License # --2-:------�/---- Phone esY`_21-ILL. Installation will serve— _ Residence FT<Partment House❑ Commercial ❑Trailer Court. i❑ {• - �._ _. Motel ❑Other -------------------------------------------- r Number of living units:--- Number of bedrooms .3----•_Garbage Grinder .-A Q__ Lot Size ___f ®_____ 100 -------- Water Supply: Public System and name __48_"_ _RQ_P____LV,4TF,-R------ 15TRCT--_----------------------Private ❑ Character of soil to a depth of 3 feet: Sand'❑ Sift❑ Clay ❑ Peat❑ Sandy Loam e-- Clay Loam ❑ ' Hardpan ❑ Adobe ❑ Fill Material _!]! ___ If yes, type __________------------- --{- i (Plot.pian, sho*ing -size of lot, location�of-system in relations 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 __ - --- ------ .......... Distance to nearest: Well ______-C_W------- -----------Foundation ____/ __________ Prop. Line ---,S_____________ LEACHING LINE r No. of Lines -----�----------- Length of each`line---.--_�?P_-------.--__ Total Length _______. �S Type Filter Material G -_-- _Depth Filter Materia) __----'D' Box/VE-5 to nearest: Well ---efJ4L1_____ Foundation A9-_-_-"�-___-__ Property Line S._�_.- `_ ..... ;J} -- 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) --------------------------------------------------------------------------------------------------------- Disposal Field (Specify Requirements) -----------------------•-- ------- =-----------------r------7--------------------------------------- -------------- ---------------------------------------------- ---- --------------------------------------------- --------------------------------------------------------------------------------------------- ------------------------------- - (Draw existing and required addition on reverse side) I hereby certify that I have prepared this application-and-th-tt-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: .. "1 certify that in.the performance-of the wotk 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." Signedrj� f�Qv Owner By -- ------ -Title - (If other than owner) s 1FOR'b EPAOTM9NT -USI:- ONLY_I APPLICATION ACCEPTED BY -__T_tR- -------------------------------------------------------- -~_-'{-----__; = } '`• T� DATE ----- - fit __`- ._-•--•--__-- ---- ----------- ----------------- ------ -------------- BUILDING PERMIT ISSUED ------------------------- ---DATE ------------- ----------------------------- _ -_-_ __ ------------------- ------------ ZZ_:_.. _ _-_. - ------ - ---- --------- ADD)fIONAL COMMENTS� ------- ---------------------------------------------------------------------------------- ------------ ------------------------ - ---------------------- - ----------- / ------- ---- - - ---- i - ------ - ---- - ------ ---------------------------------------------------- - - ----- ---- ------- - -- --- - --- - - FinalInspection -------------------------------------------.Date ------------r-------------- ----- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M f