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} y +v�F 'tir FOR,OFFICE USE: APPLICATION FOR SANITATION PERMIT p� ---------- ------------ M------------- Permit No. + (Complete in Triplicate) --------- ---------------------------------------------- I - Date Issued --------------__-____--___.------------------_ --- 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 compliance with County Ordinance No. 549 and existing Rules and Regulations: EY - (2cr—D f[0 2 0 - f _f JOB ADDRESS"'Cl-AkON .----- _: / CI ------------------ CENSUS TRACT --------_----_.-------- Owner's Name ._ / /Z 'lis -- - ' ` = -------Phone --------— -------------- Address ---. Citi" rrr .fcc`�1 = �W,- �-- � v Contractor's Name ___ -.License,# PhoneQ-. - r�� i Installation will serve: Residence ❑ Apartment House❑ Commercial :❑Trailer,Court ;❑ ' Motel ❑ Othe,671VA�;�._� A/A Wf 10- Number of living units:A_ Number of bedrooms.__-k__-_____Garbage Grinder i-__---"-4Lot Size ___ �� - A .1, P i Water Supply: Public System and'risme:---------------------- -------- -------------------------- - ---------------------Private ❑ . Character of soil to a depth of'316ei:'j" Sand❑ Silt 0,) Clay ❑_ PeaI.Sandy Loam.• Clay Loam ❑ ---. ,.Harlipan ❑ Adobey❑ Fill Material ------------- If yes,type _____-------------------- • . (Plot plan, showing size of lot, location of system in •vela#ion 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,) ' I .� PACKAGE TREATMENT [ ] SEPTIC TANK'[ ] Sie-- _X ,ac_._:� -----'_-'- Liquid Depth __ ____________________ Capacity 16-EIL./____ Type ------------------ Material__�oew:1( No. Compartments _____ ........ i Distance to nearest: WellR__________________Foundation _._.CQ_=--'.___-_ Prop. Line LEACHINGI=i ] No. of Lines ------------------------ _ ,_.____ Length of each line__________ ____---__ � � Total Length 'D' Box Z�._ Type Filter,'Material Jo /_Depth Filter Material --------------__---- Distance ______________ _.._Distance to nearest: Well ___ I r______1,Foundation ___/0-------------- Property Line _.�-------------- � t SEEPAGE PIT [ ] Depth -------------------- Diameter ------------------N6mber ---------------------------- 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) --------------------------------------------------------------------------------------------------------------- ---•-- 6� DisposalField (Specify Requirements) --------------------------------------------------------------------------------------------------------------------- ------- ------ ----------- - ----------------------------------------------------------------- ------------------------------------------------------------------ -------- r _ ------------------------------------------------------------------------------------------ ki (Draw existing and required addition on reverse side) It, 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 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 bject to Workman's Co pensati.on laws of California." Signed f `� `------- Owner BYTitle _. f other--t han owne OR .DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ___ _ ___ .__ DATE BUILDING PERMIT ISSUED --------------------------------- ---------------------------------------- DATE -------------I----------------------------- ADDITIONALCOMMENTS - -------------------------------------------------------------------------- ----------------------------------------------------------------- ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- -------------------------------------------------- --- -------------------------------------------------------------------------------------------------------------------------------------------------- - ------------------------ - ------------------------------------- - ��- �- Final inspection by: ------------- Date = SAN J AQUIN LOCAL HEALTH DISTRICT 6D� E- H. 9 1-'68 Rev- 5M