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' FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT e , ................................ (complete in Triplicate) Permit No. ............. This Permit Expires 1 Year From Date Issued Date Issued Application is hereby made to the San aquin 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/LOCATION c» Vraa.-�'t FC................. . .......CENSUS TRACT .__;��7........... Owner's No -.RL' !? -o'�� --------------- - - ---- -- Phone.............. --------------- Address ........ l;2Gs_P/- 121, ` Contractor's Namei!ru-x m-- {-rlrc .'License# / o". _Y_._ Phone .............................. Installation will serve: Residence D Apartment House❑ Commercial❑Trailer Court F ' Motel❑Other ------- Number of living units:..... ..._ Number of bedrooms ...._._.Garbage Grinder ............ Lot Size ...!i7 1- _�.............. ! Water Supply: Public System and name -------- ----------------------------------- -- -----------------------------------------------Private I Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay © Peat M Sandy Loam❑ Clay Loam;® i Hardpan❑ Adobe E] Fill Material............If yes,type---------------------------- r (PI'ot plan; showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.1 NEW INSTALLATION: (No septic tank-or seepage pit pdrmittedr''if public sewer is available within 200 feet,) PACKAGE.TREATMENT [] SEPTIC;TANK ] Size.I/ � .g .......---------- Liquid Depth .5�..................;._.- F Capacity Pqj` VType L Material- ...... No. Compartments ............... Distonce to nearest: Well ----------------Foundation...1.. .e.......... Prop. Line...__S'__.,:......-. LEACHING LINE [ No. of Lines _________________'_:_'. Length of each line-------L-O-- -------------- Total Length .....l. .o--�..-------- 'D' Box .... Type Filter.Material .. _.e...-..Depth Filter Material ... - ___________________Distan1 .. 'rest: Well ......5�.......... Foundation _......tom.........._ Property Line -S- i SEEPAGE PIT' [l� - Depthce to e - Diameter A"....... Number ___________ Rock Filled Yes No �[ e Water Table Depth -----------la -----------------------------Rock Size---F - �------ REPAIR A' Distance to nearest: Well -------L:d�_...___..._....Foundation __.a£?___._-.._ Prop. Line -.S__ ____________ p DDITION(Prey.Sanitation Permit#----------------.__.__------............... Date -------------.------_------------] Septic c Tank (Specify Requirements) ------------------------ ----------.................------------------------------------- - -------------------- DisposalField (Specify Requirements) -- - ----------------------------------------------------------._...-------------- --------------------------------------- ............................................ .... --------------------------------------------------------------- -----------------------------I...... -------------------------------------- ------------------------------- ---- (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 become subject to Workman's Compensation laws of California." ! Signed--------------------------------------------- -------------- Owner By------- 1...................... . ........ ted.... a-- - �- Of other than owner( i b FOR DEPARTMENT USE ONLY '.- APPLICATION ACCEPTED BY.....h r f ------------------ ------... DATE .3."3L- 2 Z-------------- BUILDINGPERMIT ISSUED --------------------------------------------- ------------------------------------------.........DATE-----------------.....------------ --- ADDITIONAL COMMENTS......................------------------------------------------------ -------------------------------------- ----- ..... ------------------- --- - ----------------------------....------------------------------------------------- ------------------------- ------- ---------- ------------------ - Final Inspection by:------- ------------------- --------------------------------------------------- Date ... SAN JOAQUIN LOCAL HEALTH DISTRICT 14 E.H. 9 1-'68 Rev. 5M I L;�