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{ FOR OFFICE USE: -I APPLICATION FOR SANITATION PERMIT `• / ----- - ------------------------------------------ Permit No: (Complete in Triplicate) This Permit Expires I Year From Date Issued Date Issued -. ._ S_` 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 exis ting Rules and Regulations. J08 ADDRESS/LOCATION �,?� �1l- ( �� sSl_Cr. J. TRACT Owner's Name ........ ItI5 46AIa -Phone ________-_•-_ - ------------------------------------------ -------------=-------------------- - - --------------------- AddressCity 0 -- -------------------------------------------- -- ------ A-- --------------------------------------------------------- / ` Contractor's Name ----- �1 ,Q�---= � '------------------- ------License #�[ � Phone YZs� ` _ Installation.will serve: ResidenceA Apartment House❑ Commercial XTrailer Cies ❑ ` Motel ❑Other -------------------------------------------- Number of livingunits:----,/. ... Number of bedrooms __ Garbage Grinder -/4/0- Lot Size Water Supply: Public System and name ----------------------- ------------------ -------------------------------------------------------Private Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat❑ Sandy Loam X Clay Loam Hardpan [❑ Adobe 'D Fill Material ___________ If yes, type ____________________________ (Plot plan, showing size 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 TANKSize-,& _.� Liquid Depth -- - - ------------------- .---------------- Capacity _ (:j___ Type Material No. Compartments --.;F— \J Distance to nearest: Well _, ------------------Foundation _147------------ Prop. Line ----- ._-____-_.-__ LEACHING LINE PQ No. of Lines ----/_________________ Length of each line--__-f-a--�-___.____-- Total Length _ __-____________01 ___ 'D' Box Type Filter Material141 epth Filter Material F� .................. .......:.... _ � Distance to nearest: Well/��_________ Foundation -,e-_____________ Property Line. _4?______._..__...... SEEPAGE PIT Depth __0- ------------ Diameter Number ---,/--------- Rock Filled Yes, No li }E Water Table Depth --------------------Rock Size i < Distance to nearest: Well -yf—--------------------------- --- .---- Prop. Line f------.__._..___- REPAIRfADDITION(Prev. Sanitation Permit# -------------------------------------------- Date ---------------------------------_) I SepticTank {Specify Requirements) + '----------------------------------------------•---------------------------- ---------------------------------------------------------- Disposal Field (Specify Requirements) -------------- --------------------------------------------------------------------------------------- --------------- ----------------------------------------------------------------------------------------•-------------------- ------------------=------------------ ---------------------------------------------------------------------------------------- ------------------------------------ - --------- t (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 followings - . "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 Compensati laws of California." Signed -------------------- --- ----------------- Owner ,��AJ� By --------- ----------- ------ ----------- -------------- Title ------ f /� -- -------------------------------- (I f of t an owner FOR .DEPARTMENT UAE Y �s , APPLICATION ACCEPTED BY -------- ------- -------------------------- --- DATE l BUILDING PERMIT ISSUED ------------ ------ -- -----_DATE -------------_-- ADDfTIONAI COMMENTS - ---------- - ---- --------- -----=--------------------------- ------------- --------------------------------------------------------------------------------------------------------------------------- ---------------------------------------------------------------- ------------ ------------------------------- ------------------ --- ---------------- ------------------- -------------------- ----------------------------------------------------- aCHEA - -------•------- Final Inspection by: --------- -- -- - - - -- ------------Date 0YI69------ - -------•------- SAN JOAQUIN L !STRICT ` E. H. 9 1-'68 Rev. 5M -