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f a. FOR OFFICE USE: �-� APPLICATION FOR SANITATION PERMIT -- ------------------------------------------------------ -------- {Complete in Triplicate} Permit No. ------------ -------------------------------------------- This Permit Expires 1 Year From Date Issued Date Issued _ ___:a�;:6� , Applicca�tti nlis 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 compliancewi County Ordinance N 5 9 nd existing,Rules and Regulations: I JOB ADDRESS/LOCATION r/' �r __44 ____ ` r' -<-µ �'�- _--CENSUS TRACT ----------___-•- .-� _ „W Vv - y y Owner's Name = --- '• - --- ------- - hon �Z / V_ _Q Address ----------- City - > , Contractor's Name ________ _ x . I µ ----------------------License # Phone !� �Zr'�Q7 Installation will serve: Residence Apartment House,[] Commercial :❑Trailer Court ',❑ Motel ❑ Other --------------------------- ► Number of living units:-___ _____ Number of bedrooms _____Garbage Grinder: Lot Size ________4� __ f� , �- -----------4. ---------= Private Water Supply: Public System and name ------------------------------------------------- -- *X t Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat[] ''Sandy Loam ❑ Clay Loam Hardpan ❑ Adobe w Fill Material __----___ Ef yes,type -------__________________ L (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 pyE lic sewer-is avoilable`within 200 feet,) " ' a �, PACKAGE TREATMENT f ] SEPTIC TANK f..] Size _- - -� Licjuid Depth -------- Capacity/-- __ T"________ `n Capacity/- Type �s11� _ Material �07�. .r"No � mpartments �'________- pDistance to nearest: Well - .-_____�r�_________________Foundation ___ ___ Prop. Line --_�...........__ LEACHING LINE [ ] No, of Lines ________ _ ________Length of ac line___7Q_-_______.__ __ Total Length 6-----. 'D' Box ---__------- Type Filter Mat. I ' _____Depth Filter Material _______ -J1 Distance to nearest: Well ----e- Foundation ----�70-------------- Property Line _�___._____________; SEEPAGE PIT [ ] Depth i -- Diameter - rr ��-_.-____-- Number ----------/--------------- Rock Filled Yes)d No ❑ . Water Table Depth ---------------------------------------- ----- l _ �r �+ �h'�� ----------- -- ---- --- -Rack Size of Distance to nearest: Well ------l_ ________________________Foundation ____C_Q _-___ Prop. Line _.__ ........... REPAIR/ADDITION(Prev. Sanitation Permit# -----------------------------------------.-- Date ---------------------------------- Septic ___--____________________________Se tic Tank(Specify Requirements) - T Disposal Field, (Specify Requirements) ---------------------------- -------------------------------------------- ----------- -------------------------------------- -- ------------------------------------------------- ---- = = E ------------- /P1 � (Draw existing aria 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 following: k "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 ---------------- --------------------------------------------- By -------- -------------------------- Title --------- ` - - --------- - ---- (I oche t an owner) 42 FOR .DEPARTMENT USE ONLY APPLICATION ACCEPTED BY -------------------------------------------------------------------- DATE ------------------------ BUILDING PERMIT ISSUED _ ---------------------------------------------------------- -------- - ---DATE -------------•----------------------------- ADDITIONAL COMMENT -- n = % ------------------------- -- ---- i -------- _ -- - ---'----------------------------------------- - -------- ------------------------- -=--=-------- --= a.- --- - - ---------------------------------------------- -�Final Inspection ---- - -------------------------------- --.Date ----- � --- SAN JOAQUIN --SANJOAQUIN LOCAL HEALTH DISTRICT I E. H. 9 1-'68 Rev. 5M.