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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ................................. ----------- /33 73 i (Complete in Triplicate) Permit No. .. . . .......................:.. 4 This Permit Expires 1=fear From Date Issued Dote 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: JOB ADDRESS/LOCATION ..rlF.. 6� .--- .. �iJ tti!!Y P RW.""/r!d! /#G A—.CENSUS TRACT .............:............ Owner's Name ........L.Aly---...- Y_ +. !�gz,&.......................................•------=- ----...............Phone ...................................... Address ............ -------- ................................................ City ............................ ---•--......................................... Contractor's Name 65 AV/14 a �!.... -•S�lY.................... .......License # f�6.- :.. Phone ---"• ��:. '�.. Installation Mwill serve: Residence EX Apartment House❑ Commercial ❑Trailer Court 0 " Motel ❑Other ...--•.............................•----•-- I Number of living units.....]...... Number of bedrooms ..3......Garbage Grinder -----------. Lot Size ..XA&! 1.......................... Water Supply: Public System and name .........................................................-------• --- -• -•••••......------...._......---••-Private Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam 1 Hardpan ❑ Adobe ❑ Fill Material ............ If yes,type ............................ {Plot pian, showing size of lot, locatio af. 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 f ] Size..�VV ZA A.ff -----. Liquid Depth __. ........ DO &0J - 1�r� C :� Capacity ./.IIf............. Type ...------•. r Material...G��!!��.._-- No. Compartments ..�.--•---.......__6 Distance to nearest: Well .........IA .................Foundation ....r p....__.___.. Prop. Line ............. O0, ,:t LEACHING LINE [ ) No. of Lines .......:3.............. Length of each line._---._. ~Sb._. Total Length .. -� a 6 'D' Box ....I...... Type Filter Material A !g°.cA....Depth Filter Material ...... �� Distance to nearest: Well ..... Foundation -...--.'� . ------- Property Line .... .o�_......... SEEPAGE PIT [ ) Depth , --...... Diameter _3�.......... Number ----._.3----------------- Rock Filled Yes,Z No ❑ , i Water Table Depth -------------- .......Rock Size .............. Distance to nearest: Well ..-------/ ......................Foundation ..................:. Prop. Line ---------............e 4 REPAIR/ADDITION(Prev. Sanitation Permit# ...............................sr:......... Date .................................. SepticTank (Specify Requirements) ...............................................•-------.......................-...-.......................................................... ► DisposalField (Specify Requirements) -------•--•--•------- -------•----------....------•-------................-------------------------------------..--............--•--- ------------------------ ----------------------- --•-----•---------------------------•-•---......--- y k (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 _..-- .......................................... Title .... .......................................................... (I-f of caner) t OR DEPA TMENT USE ONLY APPLICATION ACCEPTED BY .......... ... . . ...:G. ................................................. DATE ........L ..�.. .....7. 3.... BUILDINGPERMIT ISSUED .........................••• ---------------------------....................--------- DATE .................... .-----................. jADDITIONAL COMMENTS .....................I.... ...............................................=--------.......................--------------------------------- ........._...... .....--•-•...............•------.................--•---...................._....-------•-•------------- --------_......._.... ----- ---- •-• . --.......--------------- ---•--••-- ------------------- Final Inspection by: --• = ................................................... .................. ..........Date - r .—....•..-------- -----------•----.-..-...--------•----------...-----...----------..-.--------------------- SAN ._....... JOAQUIN LOCAL HEALTH DISTRICT G u 13 241-,sa oe., 4AA - - 7/72314