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P FOR OFFICE USE: i APPLIGATIA FOR SANITATION PERMIT } --- (Complete in Triplicate) Permit No: ---- ----------------------------------------------------- ---------------- ,This Permit Expires 1 Year From Date Issued Date Issued Application is hereby made to the San Joaquin Local Health District for a per to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: �,D t ____ ____ -------CENSUS TRACT -------------------------- JOB ADDRESS/LOCATION a^5 1{r,?_----- G_ z' __________________a` Z�-(� -- - - Owner's Name VG1/✓1 --- ---Phone --- City - t�`-"` T��'c Address �� -3 5 -------•---•-- Contractor's Name ------------ ------ - ----- ---------------------------------------------------- License # ------------------------ Phone ---------------------------- Installation will serve: Residence N Apartment House❑ Commercial ❑Trailer Court ',❑ Motel ❑ Other .--- ------------------------ Number of living units:---I------- Number of bedrooms _______Garbage Grinder .._.Ltd_ Lot Size SX-1--X---30 C? Water Supply: Public System and name ------------------------------------------------------------- -------------------------------- ------Private ❑ Character of soil to a depth of 3 feet: Sand'❑ Silto Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam 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 ublic sewer is available within 200 feet,) U' PACKAGE TREATMENT [ ] SEPTIC TANK Size__ _ s r----------- Liquid DePth Capacity5_COType _______ . _ __ Material_--- `KCM No. Compartments __�________________ Distance to nearest: Well __________ ___ ___________________Foundation ---------------------- Prop. Line _____________________ �- ad ---------------- Total Lenph'oZ00 LEACHING LINE pQ No. of Lines ___ _ _ _______ ____ Lengt of each line-�____ ---`--------------- Ma'D' Box Type Type Filter te I ,� -0epth Filter Material _ --------------_--------_______________ U r f Distance to nearest: Well x_5.0_ ______________ Foundation 10------------------- Property Line VO-___________----__ r1 j p Rock Filled Yes No SEEPAGE PIT Depth ___ .............. Diamefie Number Water Table Depth -- --- - - -- --------------------------------Rock Size a '7----------7--------------- i r Distance to nearest: W I . _Q___________________________Foundation r1 r__._________ Prop. Line _��_--_-_______--__ REPAIR/ADDITION(Prev. Sanitation Permit# --------- ---------------------------------- Date ------------------------------_---) Septic Tank (specify Requirements) ------------- ------ ------------------------------------------------------------------------;------------- ----- - Disposal Field (Specify Requirements) --------- ---------------------------------------------------------------------------------------- --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ------------------------ ---------------------------------------------------------------------------------------------------------------------------------------------------------------------- ---------------------------------- �,. (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 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 hec e s sect to r m pensatfon laws of California." Signed ------ Owner By -------- ---------------------------------- ------ Title ---------- --- -----;7--------------------------------- ----------------------------- (If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-4 - %------------------------------------------------------- - DATE .51Y_Y -- -0------------------- ------ BUILDING PERMIT ISSUED ------------- - --- -______------ DATE -------.------------_-----------_-------- --------------------------------------------------------- --------------- -- ADDIT ONAL COMMENTS ----------------------------- ------- - - ------ 4.�-�r5 I Ha` � V_bi6Es ElQ2 T `� i1 � - ------------------------------------ ----------- ----- --- ----- ---- -- -------!'.�----- = Final --------------------------Inspection by: ---------------------------------------------------------------11-----------------------------------------------------Date ---------------------- --- ---------------- SAN JOAQUIN LOCAL 'f)EALTH DISTRICT s E. H. 9 1-'68 Rev. 5M j