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FOR OFFICE USE: ''APPLTCATION FOR SANITATION PERMIT . , jj k- ,4 PeEmit.No.' � ------ ------------------- -- ---- _ - - ----------------- (Complete in Triplicate)- r ---------------------------------------- Date Issued --��1'-r This Permit Expires 1 Year From Date Issued Cvw _ , 0 Application i§ he eby made to the San Joaquin Local Health District for a permit to construct and instal! the work herein described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: CENSUS TRACT -------------- ----------- JOB ADDRESS/LOCATI Phone Owner's Name _ _ ,=; r -- f/►-- --------------- Address --- ----W=---�c�`(J_�a-- f lT_/ (L[f '�'� City ------.License # N��S -Phone t Contractors Name __--- --__-- ------ v E �. RA Jnstollation will serve: Residence [Apartment House❑ Commercial ❑T,ro.iler Court !❑ j •{ � a- � Motel F-1 Other---------------------------------------------- - . t -- -- --- -_--- r. (•-g- its:.----)____ Number of bedrooms &----Garbage Grinder _ --- Lot Size ____ - Wateb Supply:er of IPubl ctSystem and name ----------------- ------- ----------------------------------------------- -Private, Character of s"oil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ :Clay Loam ❑ _ Y YP._. �-- - --- = P I7- Hard�an Adobe' Fill•Nlaterial !f es, t e -------------------- in s ie+of lot location of system in relation to wells, buildings, etc. must be-'placed on reverse side.) �{ k (Plot plan, showing t NEW INSTALLATION: {No septic tank or seepage pit.permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT '[ �.� SEPTIC TANK'(�� Si -- --. _ Liquid Depth ------------------- J� 7L__-__ _.___ No. Com artment ---------• Capacity ,/-c Q _- TYPe _10,-. -- -Material ��'`�` A / I ; / Distance to nearest: Well _____ __ _� __:____-_____Foundation - -a------------ Prop. Line __ ________________ LEACHING LINE r No. of .Lines ------ - Length of each Iine��Q�-/da-- .Total Len th _aa_�-------------- g f -- g � 'D!'� Box _�� Type Filter Material Filter.Material -_f 6--C--,- -------------•-f- --- ---------- I. X Line --- nearest: Well - EV / _Distance - Foundation - Property i SEEPAGE PIT , [ Depth. cL�-`-------- Diameter _'__ Number p Rock Filled Yes �.]' No .i❑ Water Table Depth -----------_ ------------ -----Rock Size -i_11- I -d / / Distance to nearest: Well -------/�2--e---------------Foundation ----- - Prop. Line _ ---------_-------- REPAIR/ADDITION(Prev. Sanitation Permit# --------:=----------------------------------- -Date --------------- --------- } Septic-Tank (Specify Requirements) ----------------------------- ------------------------ ------------------------------------------------------------ - - - ------- - Disposal Field (Specify Requirements) -----------------------------•--------------------------------------------------- ----- -- t ------------------------------------- ------------- ----------------- ------------------------------------------------ --------------------- -- :: ,. r (Draw existing and required addition on reverse side) i I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin I 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 ------ --------------- --------------- ------ Owner ------ ------ Title _----- ------- - - ----- -- ----- --------------------------- (If otherda owner) FOR DEPARTMENT USE ONLY 1 Q APPLICATION ACCEPTED BY __ _ _ DATE ____--i{?- yb-•/-- BUILDING PERMIT ISSUED ____-- -- __ __ _ DATE ---------------------- --- ------ -- ----1----------- ---- ---------------------- ------------------------------ ADDITIONAL COMMENTS ________________ __- ----------- ---------------------------------------------------------------------------------------------------------------------------------------------------------- - -------------------------------------------------- ---------------------------------------I-------------------------------------------------------- --------------------------- --- - ----- - —----------------------------------------- --------- ----------- --------- n ____________________________ V _ ______ � ------------- -----•------ ----------- ----------- ----Date �:------ �----� ----- - � Fina! Inspection by: t'��rz--�"-- ---- ------------ ---------- - - - - + yam___ -ice !r..�=.. ✓. '// SAN JOAQUIN LOCAL HEALTH DISTRICT r E. H. 9 1-'68 Rev. 5M. /� G