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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT _ -- -------------------------- � Permit No. (Complete in Triplicate) `a ------------------------------- -----------0,------------ F'• � Date Issued ____ __ " J:: __"_"" .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 des.cribed-This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: Fr g � JOB ADDRESS/LOCATION ____________ �-- - CENSUS TRACT -----------------_________ v, 1 �. - Owner'slName -- xfc� -fr>�`-------------• Phone Address ' r----- -- Y --------------------- "Cit Contractor's Name __C � `ECJ ``-- z- ----------------------- License # 02"5 1 3 Phone Ilk Installation will serve: ResidericeXApartment House❑ Commercial ❑Trailer Court ;❑ Motel ❑Other Y _ x , Number of living units:_______ Number of bedrooms _._a____Garbcge Grinder ------------ Lot Size i �S , Water Supply, Public System and name ---------- ------------------------------------ -----------------------------------------------------#--------Private>( Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay .❑ Peat❑ Sandy Loam ❑ Clay Loam.E:] Hardpan ❑ Adobe 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 TANK f ] Size----------------------------------------- ---- Liquid Depth ---------------------.----. y^ Capacity --------------------- Type `----------- I--- Material---------------------- No. Compartments --------•--• --------- Di stance -------- Distance to nearest: Well -----------------------------------Foundation ______________________ Prop. Line ------_--------------- LEACHING ___.-..________-__. _LEACHING LINE [ ] No. of Lines ------------------------ Length of each line---------------------------- Total Length ,__-__-_________....._.._--_ 'D' Box ------------ Type Filter Material --------------------Depth Fitter Material _-------------------.-_.------------.-.:..-- Distance to nearest: Well -- _________________ Foundation ------------------------ Property. Line ........................ I __ Rock Filled Yes � SEEPAGE PIT [ ] Depth -------------------- Diameter ---------------- Number -----------•--------___--- [] No .i❑' ' Water Table Depth ---------------I--------------------------------Rock Size ---------------------------•---- t Distance to nearest: Well ------- -------------------.------------Foundation -------------------- Prop. Line ---------------------- REPAIR/ADDITION --------------------REPAIR/ADDITION(Prev. Sanitation Permit# --------_----- ----------------------- ---- Date __________________.______________} Septic Tank (Specify Requirements) '0'-- ------ I-- --- -------------------------------------------------•- -----------------------,..-------------------------- Disposal Field (Specify Requirements) -------__ _`_""_-- "-• - ------1-/......... ----------------{-- -'---------------------------------------------------------------------------------- -------------------------------------------------;-------------------_------ -------------- -- ` - --------------------------->---------------------------------------------------,---------------------------------------- (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 Saiz Joaquin Local Health District. Home owner or licen- sed agents signature certifies the following: =� "I certify that in the perform ce of the work for which this permit is issued, I shall not employ any person in such manner g € " " - of California." Sis ned to e e ub'ec t Wo an's Co cation laws r"-"-" -_�__'Ov�7ner - �. .y . a :•BY y If other t, - -- -------- - Title s � ( han owner} � i ( FOR DEPARTMENT USE ONLY ' . APi'LICAT[ON ACCEPTED BY DATE ----1 - yf� ' BUILDING PERMIT ISSUED ---- ------- �, DA7� ADDITIONAL COMMENTS __ ` �__ ca+-�_.-�f�� y��.c�r' Pte?=----•----------- --------- ------------- -- ----------------------------------------------------------------------------------------------------------------------,-------------------------------- ----------------------------------------------------•- 'i ----------------------------- — _fin_ ------------'------- Final Inspection by �G6'E- 0_ ,mss Date SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M