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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT � -------------------------- ------------------------------ (Complete in Triplicate) Permit No. ---------- ------ ------------------------- TThis Permit Expires 1 Year From Date Issued 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 ADDRESS/LOCATION .-----��-`I-UY --,---- :-------�QfGI ,tJ------L°c� I�-` ----- .---CENSUS TRACT ---------:.............. .. Owner's Name -------;477a5- --------------------------------------------------Phone --- i-_ 0-a- ---- Address - ----------------C -40n e-)-----------------------------------------------------------_. City -------------------------------- ----- Contractor's Name -----!Q- '2, --------sS--45-tNi�2--------IA.-Cr--.License # Phone Installation will serve: Residence -Apartment House❑ Commercial ❑Trailer Court ',❑ Motel ❑Other -.-.-- Yt- Number of living units:----A- ---- Number of bedrooms ___Garbage Grinder -----7---- Lot Size --------2.------_�---_-_---� Water Supply: Public System and name -------_--_`_T-6_A-V_o+_�_�._-_____-J . ------------------Private Character of soil to a depth of Z feet: Sand;❑_ Silt❑ ., Clay ❑� Peat❑ S_ andy Laam ❑ Clay Loam ❑ ; Hardpan ❑ Adobe Fill Material ------------ If yes, type ____________________________ (Pl'ot 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 TANK.[ ] Size------------------------------------------------ Liquid Depth -----------------.__,...__ Capacity -------------------- Type -------------------- Material---------------------- No. Compartments -------...-........... r Distance to nearest: Well ------------------------------------Foundation ---------------------- Prop. Line ----------------- LEACHING LINE LINE No. of Lines -------- I-------------- Length of each line----------J7tJ---------- Total Length ---------WP---••-----.- AV - 'D' Box _W-_�_ - Type Filter Material _S*_fes '-Depth Filter Material --._._._---_--_l_ Distance to nearest: Well -----L4-'V_........... Foundation -----LQ r.-._...____ Property Line SEEPAGE PIT - ] Depth ____a ...._.... Diameter ----- _H___ Number --------- --I--------- ---- Rock Filled Yes J' No i❑ AVJ? Water Table Depth ----r -------------------------------------------- Size -------- ----- Distance to,nearest: Well .____-I m0_'-------------------------Foundation ____J ._.....r_ Prop. Line --__1q....... REPAIR/ADDITION(Prev. Sanitation Permit°#'________________________________ Date ___._________4__________________.-} Septic Tank (Specify Requirements) -------------------------------------------------- ----- ---------------------------------------- ------ r ------------- 00 Disposal Field (Specify Requirements) ------- �7,a j - _-_ ----Ta___-_---� �-s�� ---�-------------�_ _ - --------------- -------------------------- ------- -- - ---- ------------------ - ----------i'---- ---(-- -- ---------- -- - -- ------- ------- --- ------ --` ------------------ ' r-e.:�e�ur-+�•.�t„=,�.-.�-*�. �r -R-�..T.�r .__ �-•�. - - - - - - ,..,« ...:.....-tet---- � _ .. - - - .+ ---- -------- -- - - ------------------- f (Draw existing and required addition on reverse side) I hereby certify that I have prepated 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: t ` "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 '.Ti F%,£' - `S['~ ✓L -- Owner _. BY ---------- - --------- -------------- Title ------------------------------------------ --------------------------- (If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ---- DATE ..- 1 ~X- BUILDING PERMIT ISSUED -------------------------------------------------------------------------- - ---------- ---DATE -------------•----------------------------- ADDITIONALCOMMENTS -----------------------------------------------------------------------------------------------------------------------------------=--------------------------- ------------------------------------------- -------------- ---------- ---- - ------------------------------- ---------------------------------- ----------------------------------�;-------------- -- -------- -- -------- ----- - Final Ins ection b P Y- - ------- ------ - - ----- - - ---------- --- ---=-----------------------------------Date SAN JOAQ N LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M