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FOR OFFICE USE: NPPLICATION FOR SANITATION PER►"T -------------- ----------------- ------- ... Permit No. -- - - _ ----------- - (Complete in Triplicate) - ��- This Permit Expires 1 Year From Date Issued Date Issued6.' 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 compliancewithCounty Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION _'-7r� - --EL ----3r Al N -F --CNI '------111TO�-CENSUS TRACT ---- `�'-'........__-. Owner's Name /V -94 e-1Z. �/R.S.G- ----------- --- --------- ----------Phone 0 ." ` .t � I✓ - r� //� n ��/� I Address l � eSc-1�.C2 � `,L2P!Y. �h--`•.��f�4Lity � � ��- - -- - - - Contractor's Name - _..License # -- 391 - Phone Q� (��Ld ---- ,->� '---��2 �J �/- - -------------' -- Installation will serve: ResidenceApartment House F1 Commercial ❑Trailer Court ❑ Motel ❑Other ----- ------------------------------ Number of living units:.-_A------ Number of bedrooms --A-----Garbage Grinder - Lot Size --- ,9.�-..-.._----- Water Supply: Public System and name ---------------- ------------------------------------------------------ ------------------Private gr'' Character of soil to a depth of 3 feet: Sand ilt C) Clay ❑ Peat❑ Sandy Loam ❑ 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 TANKI ) Size --------- ------- Liquid Depth __......_.-.-..__---- R1 Capacity .. ------ - Type ----- ----------- Material. -- - ------ No. Compartments --------------------- Distance ------- ------ -----Distance to nearest: Well _ ----------- -----------.--------.Foundation ------ -------- Prop. Line -----_------------- LEACHING ---- ----------- --LEACHING LINE [ j No. of Lines ----- Length of each line....____--------- ------ Total Length ------.-._-.------_-- -... 'D' Box ------ Type Filter Material --------- _----.--.Depth Filter Material .....--------------------------------------- Distance to nearest: Well -._ ----------- ------- Foundation - Property Line -------------------- SEEPAGE ...--_............SEEPAGE PIT ( ] Depth ____.........--- Diameter -------------- - Number ---- ------- ---.---- Rock Filled Yes ❑ No C] \ Water Table Depth -- ---------- ------------------------------Rock Size Distance to nearest: Well ---------- -----------------------------Foundation ---- Prop. Line ..-_...- REPAIR/ADDITION(Prev. Sanitation Permit# -------- ----------__------- Date ----------------------------------) Septic Tank (Specify Requirements) ----- ------1-3- ---- - - -------7------------------------------------ --------- - ---- --- ----------------------- - - -------- Disposal Field (Specify Requirements) -------Irm-D----------I--`�---- ----36--------W 1--D' ---- "CH.__�-L .. -0------F_. cisTzn[6r_..---SYST Al-- -/N_Grt94nC---- --Arf;;-; ,r----- CUNRETT7 f}-wffS- -- --------- - -------- --- - ------- -------- - - --------- - - - - - (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, 1 shall not employ any person in such manner R�\V as to bec a ubjJec—t to Workman's yy CIO laws of California." Signed -- -f-/." �-i\-/1. ----------------------------- Owner By ..._.....- - - --- ---- - --- ------ ------------ - Title - (If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY -fitR�p---- - ------- --------------------------- --- ------------- ---- -. DATE -.7) BUILDING PERMIT ISSUED ---- ----------- ----------- -- --------------------------------------------- - - -----DATE ADDITIONAL COMMENTS ------------ - -- - ----------------------- --------- - - ...-. - - -- - - - ---- --- ---- - - /---------------- - - - Final Inspectipn b : -- - - + � ---------- - -------Date SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M