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f FOR OFFICE USE: APPLICATION 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 permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549 and existing Rules pnd Regulations: r 1 ) n e!/a JOB ADDRESS/LOCATION ..q...SpU �l1p.'. 0f .T/f...1"—��-- 6.CENS TR,ACT� ry ... Owner's Name _11 1./.Z...C-YI ----64_Z f'�/V/------------ ............... .......... ............... . ._.... .... -------------....Phone Address ..Z.o 9 ........................... CI �., 1�RrZ�/I�------....------------------- ----License # cY.a 1L - Phone Contractor's Name .__.. -- _.�......... . . ... -_-- Installation will serve: Residence g Apartment House❑ Commercial❑Trailer Court C Motel ❑Other---------------- - ------- ------------ 7 Number of living units:__..... Number of bedrooms ___, 7..Garbage Grinder ------------ Lot Size _- � '/ ...._............ 'w Water Supply: Public System and name --------------------------------__----------------•--------------------.....-__...._.....Private Character of soil to a depth of 3 feet: Sand tg Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam❑ Hardpan ❑ Adobe ❑ Fill Material ------------ If yes,type _......._................ p (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) 14 NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is availabl within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK q ] /Ma Size----- .:---- __-.._--__.-. --- Liquid Depth ----_._---._..-..,....- Capacity ----------.---- T - - - - Mater' I_......-............ o. Compartments .................. Distance to nearest: W ----- ------ -------Foundation --------. Prop. Line ....-.......------- . ` LEACHING LINE [ ] No. of Lines -------... -------- ength of a line.:...__...... ._....._. Total Length ._...........:............. p� 'D' Box .._....._. Type Fiaterial .-.. -_-_._....'_Depth Iter Material .._........................................ Distance to nearest: We _.. .. _.. Foundation ...._.._..._....._. Property Line ........................ SEEPAGE PIT O Depth . Dia ------ ...._. Number ----------------_.._-.--. Rock Filled Yes No >❑ Water Table Depth .... . .... ........................ ock Size .Distance to nearest: Well - _---._._..----._ .... ....Foundation Prop. Line ........._........... REPAIR/ADDITION(Prev. Sanitation Permit# ...... ...... ............. . ... ate ..._.............................I Septic Tank (Specify Requirements) ---------------- -- --- - `-.: ---------_............................--.-.......------..........._..._............ Disposal Feld ( peciN Requirements) __--. -- /LYS .f 1�11Q--7-/7' .... � ✓ /a /LOA.-- �- •��-��. lt �Izv- s ................................_.................................... ............. - .----------------- - ................... --........------------ -- --------- ------ (Draw existing and required addition on reverse side) 1 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, 1 shall net employ any person in such manner as to become subject to Wor an's Compensation laws of California." j Signed --- - -- ----- --- - - - --- --- ------- -- - --• Owner ' -------------------- ------ By ... �.-. ... .. __......... - -........ Title ........ -.._-- - -- ----------- -- --------- (If other than owner) R EPAiITMENT USE ONLY APPLICATION ACCEPTED BY.... -- ... ....... - ..........._......._...-----... DATE --b-�'�-`'-�� f---------- BUILDING PERMIT ISSUED --------- - ................. . ---- -------------- -......------ *............_ -- ------- ----DATE -------------- ADDITIONAL ---------- - - - - - ADDITIONAL COMMENTS .................................. .......... - ...._......- _... - --------- - -- ........... ............... .......................................__...... ........... ......................... ... -................ -- ------ ------------ ...... ----------- ----------- -- - ------------ ----------------- ------- - ------- --- -- . . .. ........ ............._ ... .. ..---_- -------------------------------- - - ---- ------ ---- --- - -- --- - - ------- Final P Y� --------.._ -- - - ---. . . - Date ......_..----`/.......... .. Final Inspection b �. � ................ . ....... . ... . . - - �� —� SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1•'68 Rev. 5M.