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,/FOR OFFICE USE: I' gPPLICATION FOR SANITATION PF' 'IT ------a�- G t-`- �- ----- r (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 compliances with CouZY4 rdinance No. 549 and xisting Rules and Regulations: JOB ADDRESS/LOCATION ../. lr .— _/C,�.•�LZf (ie 2 ✓ --CENSUS TRACT ....................._... Owner's Name - - � rW ' �JSQ/!---------------------------------�-----l----------------Phone Address - ?�h` � `------------ ----------------------------------- ---------. CitYL��4�t'e�- y--------------------------- ... Contractor's Name ---------_tet, - ��'/G- ---------------------------License Installation will serve: Residence.Nd Apartment House❑ Commercial ❑Trailer Court ;❑ Motel ❑Other ------------_- -------- ------ Number of living units:-./...- Number of bedrooms .......Garbage Grinder IVO-- Lot Size ------------ Water Supply: Public System and name -------__----------------------------------------_ ------___-------------------------------------PrivateX Character of 'soil to a depth of 3 feet: Sand Silt❑ Clay ❑ Peat E] Sandy Loam E] Clay Loam F]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 public sewer is available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK Q ] Size--------- -_------- ------------ Liquid Depth -_-----------------_.--. y\� Capacity --------------- - Type ---------------- Materia[--- -------------- No. Compartments ------ ............ p Distance to nearest: Well _- --------------------............Foundation ---------------------- Prop. Line .._---- LEACHING LINE [ ] No. of Lines _-__------ -:------- Length of each line_- ------------------------ Total Length -------- ---....___-----. 'D' Box ---------- Type Filter Material ...... -------------Depth Filter Material -------------------------- ---- --_.---- Distance to nearest: Well ------------------------ Foundation --- ----------------- Property Line ----.-----------........ �V SEEPAGE PIT [ ] Depth --------- ---_ ---- Diameter ---------------- Number Rock Filled Yes ❑ No ❑ 1 Water Table Depth ------------------------------_-_-----------Rock Size ------------------------------ Distance to nearest: Well --------_----------_----__-------..Foundation -------- ..... Prop. Line -------------- ------- REPAIR/ADDITION(Prev. Sanitation Permit# -------- ----.------------------------------ Date ------.------------__----------- Septic -----------Se tic Tank (Specify Requirements) -.----------- --- - - - x - -- I - ----------------- W �-- --- . Disposal Field (Specify Requirements) .--.. 40'. 0' I -X— / -�f - ------------------- ------------ ------- -------- -- -- re .. ��t�i------��,r r ----------------------------------------------- ---------------------------- ---- ----- - - - � ---------------------------------------------------- - - ------------------------------------------------------------------------------------------------------- (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 Co pensation laws of California." �\ Signed ... - - - - ------ ------------ ----- Owner A014- By - -- -- - - Title ... :> - ----------- ---------- -- ArVI other than owner FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED - G)'o�?_� N. --,__>,A �-t _ - DATE . �'— Y . ----------- ------- BUILDING =-- --------- BUILDING PERMIT ISSUE - ------------------ ----- --- - --------------------------------- --------------------- --DATE ADDITIONALCOMMENTS ------ ---------------------------- --------------------_--_ - ----------------- --------- ---- --------------__--------------------------- - - --- _ ------------------------------- - ------------ ---------------- --L-�lc.(v - Final Inspection by: - -�-------;_X - - - -----------------------------------Date --. .. -. SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M