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FOR OFFICE USE: - -- — S.APPLICATION FOR SANITATION PER-*& -- -- — o S! (Complete in Triplicate) g i ; . - __..._ - .--..--- -_-.-__._ This Permit Expires I Year From Date Issued ' • ' ed 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/LOCTI N -------------------------- ------ -----CENSUS TRACT ._--__--_----..-_._-. Owner's Name -- Phone -------- _ Address ---- V7X- - - 39` ]zee -- - - -- ------- . City --- - - ------..----- ----------------- -------- Contractor's Name ...--.-. e�:1-- _- - - � - -s----------License # -_1Q l_3_P` Phone ---------- ----------_---- Installation will serve: Residence Apartment House C] Commercial❑Trailer Court F]r , Motel ❑Other -j----------- ----------------------- Number of living units: -.-_ Number of bedrooms _ _-_-_Garbage Grinder -_ __--_ Lot Size y -_ _-____._ -__ ._ `---------- _ Water Supply: Public System and name ---------------------------_-------_.-------------------------------------------. . -_---_----------Private [� Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat❑ Sandy Loam zr�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 seepage pit permitted if p�lic ewer is available within 200 feet,) i PACKAGE.TREATMENT [ ] SEPTIC TANK [ Size_��___�___ C--*f_-_.__.- Liquid Depth _ -_.____-----,...__ Capacity -1- Ij ��-- .Type f"J",6 1 Material�ac0----_-__ No. Compartments _..fir....... YY i �r Distance to nares : Well _---____-_-��_�-_____-_......Foundation _-j-O-______--__ Prop..Line __� ............... LEACHING LINE _ /No. f Lines .. [yam q � ___ Length of each line_ �o_�_-- _--_.--_ Total Length' �f��. ........_-. D Box 10 . L -IlWpe Filter Material -_- ---__Depth Filter Material � " - I Distance to nearest: Well ._-.:-_ !d.--_-.- FoLoation ----N--------------- Property Line -. ___---___- SEEPAGE PIT [ ] Depth -------------------- Diameter .__-- ---- Number ---------------------------- Rock FilledYes ❑ No ❑ Water Table Depth -_r .._ _r5 ¢........ . .......Rock Size -r�� '_fl _.....-.._-- Distance to nearest: Well ---------------------------,__.........Foundation --------------- .... Prop. i!Jne .:-_-----___---..--.. REPAIR/ADDITION(Prev. Sanitation Permit# -------.----------------------_.----------- D9te':____ t__';_._.._) _ L Septic Tank (Specify Requirements) ---- --- - --- --------------------------------------- ---------------- ---------- -...-------- -'.,.... `------------ .... Disposal Field (Specify Requirements) --......... ---------------------------------------------------------------- ------------------------------------ - - - 6. --------------------------------------------------------------------------------------------------------- ------------------------------------ -------------------!----------- - - - '(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 ,wits San Joaquin I. County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Homs 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 L as to beco subject to Workman's Compensation laws of California." Signed - -- ---------------- co ��} - - Owner By - - - �c� "� ------------- ----- Tit - - L ------ ------ ----------------- -- -------- (If other than owner) df FOR DEPARTMEN USE ONLY APPLICATION ACCEPTED BY - ---- ----- - ---- - - ------------ ---- ------ DATE --4- ..---------------- BUILDING PERMIT ISSUED -- -- -------- -- - -------------- . - --DATE ------- ----- ------- ----- ----------- ADDITIONALCOMMENTS------------------------------- --------- ------ -- -- ------- -- ---------- ---- ---- -------- -------------- ...--- --------------- Final Inspection by: __ ...____..____.Date ----------------------------- ----------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT r. E. H. 9 1-'68 Rev. SM