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F9R OFFICE USE: � .+.• APPLICATION FOR SANITATION PERMIT ------- --------------------------------------------- Permit No. ----------------------- IV � -`-�p - --------- - - 4Complete in Triplicate) SLANNrill V ate Issued -------------------- - ---------_-----------------------------_---_ This Permit Expires 1 Year From bate 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/LO919- ION .--`- __-ZIef `-5--------- rf -- CENSUS TRApCT ---- ___ __ - �-- ----[ 1 - ----------------------------- -------------------Phone -,?;-?,._ �-- -- Owner's Name _._ ,� Address _1� Z--�//-------- -------- /1,Fme_/-z------------------------------. City �ciGr le__.�---------------------------------------.__---- Contractor's Name ''="F --�r+ f �f L�� _T-- - / __ Phone :aP-P-- -----------------------------------License Installation will serve: Residence Apartment House❑ Commercial ❑Trailer Court Motel ❑Other ---------------- -------------------------- Number of living units:-----I----- Number of bedrooms ---S-----Garbage Grinder -.---------- Lot Size - 7 --------- in Water Supply: Public System and name -------------------------------------------------------------------------------- -----------------------------Private Character of soil to a depth of 3 feet: Sand'M Silt❑ 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 seep it permitted if public sewer is available ailable within 200 feet,) yt PACKAGE TREATMENT [ ] SEPTIC TANK;; Size___ __ _ .�_� ______-___ Liquid Depth _'_fir______.__._-- Capacity ,/�0-6------- Type _____ MaterialCar No. Compartments _S________________ tante to nearest: Well __4�3_ -----------------------Foundation . LEACHING Prop. Line ----6�---------.-- -- ------------------- Length of each line_._- -_-- f LEACHING LINE No. of Lines � g ��-----.-------- Tota! Length _ 2945______________ * /rte_ Type Filter Material _iC -Depth Filter Material --� 'D' Box _ ----------------------------------- '67 Distance to nearest: Well _____6 r________ Foundation ------J-0_f Property Line ___ ............. SEEPAGE PIT [ ] Depth --------- ---------- Diameter ---------------- Number --------------.------------- Rock Filled Yes ❑ No C] WaterTable Depth ------------------------------------------------Rock Size ------------ ------------------- Distance to nearest: Well ----------------------------------------Foundation ---- 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: "1 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 o Work n's Compensation laws of California." Signed _ - - ------------- - - -- -----------�-- Owner a BY ------------ ---`------ --------- ----------- --------------- ----------- - Title --------------- ------------- ---------- --------------------- (If other than owner) FOR DEPARTMENT USE ONLY +* . DATE 7 _ ------ APPLICATION ACCEPTED BY __ �l ' ---------------------------------- --------- • F BUILDINGPERMIT ISSUED ------- - ------------------------ --------------------------------------------------- ---------DATE ------------------------------------------- ADDiTIONALCOMMENTS ---- -- ---------------- ------- --------------------------------------------------=-------------------------- ---------------------- ----- ------------- ------------------ RFina lInspe = t-------------------------------- ate _. SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M