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FOR OFFICE USE: rPLICATION FOR SANITATION PERI Permit No. -----------------------------•--------- ------ (Complete in Triplicate) --- =---------------------------------------------- Date Issued --------------------- ---------------------------------- I___I This Permit Expires 1 Year From 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 and Regulations: 7000 E- I JOB ADD ESS/LOCATION ._�j -�� JA--------WOVEV_�-----VZO-1-1-11CAY --CENSUS TRACT ---•-- Owner's Name n -��_ _/ B-1 c -----P/hoone •----------- Address _ 1 -� �.�s' City P &-5;_7------------------------------- 6�^'Y97 Name ---- - �A- =� ------� t ------------------------------- .License # _��.?r� Phone��`�'��---•---•- Installation will serve: Residence ❑ Apartment House❑ Commercial :❑Trailer Court i❑ Motel ❑ Other _.�a_ 0 G_P------------------------- Number of living units:------------ Number of bedrooms ----------..Garbage Grinder ------------ Lot Size ---/9C �-'��'---� Water Supply: Public System and name ------------------•--...-.---------•-----------•--------------------------------•------------------•- ------Private Character of soil to a depth of 3 feet: Sand' Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay-Loam:❑ Hardpan ❑ Adobe ❑ Fill Material ---------_- If yes, type ----------------------___-- N (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) N NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) top PACKAGE TREATMENT [ ] SEPTIC TANKSize-4-)---"_5 Liquid Depth______._______...------ Q CapacitylZ--_------ Type +P/ -A5.r. Material-(2C'1No, Compartments ------------ -------- �is ance to nearest: Well ------------------Foundation ----------- Prop. Line LEACHING LINE ( No. of Lines 0--)------------- Length of each line---l.!'0-___-..---__- Total Length _f_t2L ---•---•------ 'D' Box .J�-_- Type Filter Material Filter Material ---1_�--.....---------------------- :.--- Distance to nearest: Well -1-600--------- Foundation . C-------------- Property Line. .L-_6-...........:.... SEEPAGE PIT [ ] Depth _.------------------ Diameter ---------------- Number ---------------------- ----- Rock Filled Yes ❑ No .❑ WaterTable Depth -------------- ---------------------------------Rock Size .-----------•------------------- Distance to nearest: Well ----------------------------------------Foundation -------------------- Prop. Line .................. REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date ----------------------------------) 4 Septic Tank (Specify Requirements) ----------------- - ---------------- ..-------- DisposalField (Specify Requirements) ---•--------------•----------•---------------------------------------•----------------------------------- ---------•-------_------- ------------------•-- --------------------------------...----------------------------------•-------------------- ---------------------------- --------------------------------------- -------------------------------------•--------------------•----------- ------ (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 Workma s Comp nsa[ion laws of California." Signed _.. = `=tt `��i -t- ---------- -----•- Owner r 9 4�= ---- /� . By _�--sr:._._l./C- ;�. r:�.��-=' .. Title - '� ( ther than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY -- ---------------------------------------------------------------------------- DATE BUILDINGPERMIT ISSUED --------- - -------------------------------------•----- --------------------------------------------------DATE -------------•-----------•------- --------- ADDITIONAL COMMENTS - --------- S ---------------- --------- ----------------------------------- -------- --------------------- - -- ------ --------------------- ------ � � Final Inspection - -------------------- ----------Date ----. .5-- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M