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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT. ---- .� t- .,u�• Permit No. - _ - ---2--�-�. - �- - (Complete"in-Triplicate) _._.____.__.____-_-_----._.--._____..__- __3._'_2_o__-. � _._.___________ --------------------_---_------------ bdte Issued This Permit Expires 1 Year From Date Issued r w + � 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 !!- -�C__/.p_1---- ---------------- - - -;� Cak----.----CENSUS TRACT - ----------- Owner's Name .---- ----!---------------- -------Phone ------------------------------------- Address ---------- ---- - ---- ------------------------ ---------------------- --------- -- ----------- ----- Address - ---- ----------------- City --------------------- ) Contractor's Name __ _ _ __________ _ __ '.__4�AL_C •e_____ ----- _ v,<-p-_.License #a4;S7_S'_1.7__ Phone _C1-�-Q-=_�1�' R' E � i ! Installation Will serve: -Residence (Apartment House❑ Commercial ❑Trailer Court ',❑ i i Motel ❑ Other ---- t Number of living units:_______ Number of bedrooms -___.----Garbage Grinder ------------ Lot Size 14' -5,7�-_- ________ I Water Supply: Public System and name --------------------------------------------------------------------------------------------------------------PHvatex Character of soil to a depth of 3 feet: Sand'E]p ❑ Silt❑ Clay ❑ Peat ❑ Sandy Loam Clay-Loam;:❑ Hardpan ❑ Adobe ❑ Fill Material -----]------ If yes, type-------------------------I --- fJr- )Pl'ot rplan, showing size of lot, location of system in relation to wells, buAings, etc, must be placed on, reverse side.) NEWklN5TALLATIONi - (No septic tank or seepage pit,`permitted if p14 ublic sewer is available within 200 feet,){ PACKAGE TREATMENT ['�, SEPTICTANK'[ J Size__J _ ----�____._ q p `T fp r +p ---- Matericsl_C.��------------------- Liquid Depth --� ------------------ � t Ca acct l ------ Type _ _-` _--_ - _ No. Com artments ----- -------- Distance to` nearest: WeII ) t -----j---`��-�------------------Foundation� ---------------- Prop. Line ------•- LEAC�LINE ] No. of Lines --- ------------------ Length of each fine--__ _ --------- ----------- Total Length ,_--+{-------------I-------_- r �c D' Box------------- Type,Filter Material --------------------Depth Filter Material --------------------'------------------------ { Distanceto nearest: Well -- - -- _- Fcuridation -_—_ 7 --r -Proper-ty-Lirve-r ------------------ SEEP SEP GE PIT [ ] Depth ____________________ Diameterx____-__ Number ---------- ----------------- Rock Filled Yes,�J No 0 � t Water Table Depth ------------ +/- -------- -----------Rock Size -------------- ----------------- r . � I ] Distance to nearest: Well ------ ___r-___------- +)__-_-.__.-•__----_Foundation ----------'_-- _____ Prop. Line ______________________ REPAIR/ADDITION(Prev. Sanitation Permit# -------------------- .--------_----------__-- Date --------------------------- ____-) Septic Tank [Specify Requirements) -------------------- = - i Disposal Field (Specify Requirements) ---------- &- = ----------------------------------------------------- ----------------- -- ----- -- ---- -------- - E -------- -------------------------------------------'- ------- ------------------------------------- ------ )Draw existing and re✓ired addition on reverse side) I 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." i { ) 9 Signed ----------------- Owner ,... By ----- Title -- ------ ---- -------------------------------------- i -- ]If othAthan owner) « u .. -- -- - + - _ - I " FOR-DEPAitTM'INT-USE-QNIY------- ' APPLICATION ACCEPTED BY ..__ _ ___._ _. _ __---: -------------- DATE __. '�/�- - -----J4--_--_-- - _ _ BUILDING PERMIT ISSUED--------- ��----- ------ ------------------------------------------ �-�----- DATI ," - ----- ---- --{-------- ADDITIONAL COMMENTS ----------------------- ] ------------------------------------------------ ----------------------------------------------- G -------------------------------- -------------------------------------------"------------------------------------------------------------------------------------------------ --------------------------------------------i`[ --------- --------- --------------------------------- ---- ----- __ __ ____________ __- --- -___-- __ _ ____ _ ___ --------------- `Final Inspection by: -----------------------------� -- _ - - - - - Date -J_ _- -- -[- ____-- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M -