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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ........... ---- -- -- ---- - Permit No. _20--.�- - (Complete in Triplicate) 7 ,3� 70 �� - ------ -------------- Date Issued _ . -` - --------• ----- -_ __----------------- This Permit Expires 1 Year From Date Issued Application is hereby made to the Son Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in compliy4r_ with County Ording7ce No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION - _lC._ ~• .. CENSUS TRACT __________________________ Owner's Name .... ------------------------------- Phone Address ----Ill-/2A------- �- -----. CityGf�li' �C' - [1 +� �"4 License # . - .. ..... Phone Contractor's Name ��kl j�-C(L_ L.C�__..:. .< � '- /- Installation will serve: ` Residence ❑Apartment 116use❑ Commercial ❑Trailer Court :❑ Motel ❑Other -------------•--------------- ------------- _ Number of living units: _11 ' -__-.- Number of bedrooms _� _--.Garbage Grinder -,l,jr<-_ Lot Size ----�,1-__-. t 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 ---------.---_----_------- (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 [ I SEPTIC TANK eize.-- --_ SF�--- ------ Liquid Depth ....-. -.--'-.-- -.-_.___Capacity - -Z-C4------ Type d' +< !�I"--- MaterialCo[a, No. Compartments -.--J"'.._.....__ l Prop. Line -_------------------ raj Distance to nearest- Well ---- -.�-_.---__.-.--_---_---Foundation - ------------ �+ f LEACHING LINE No. of Lines .--. --___._-_ Length of each line ------- Total Length --_---�. __-1___..._.__ 'D' Box _j------ Type Filter Material f-1-_--._Depth Filter Material ----- -----`------------------------------- Distance to nearest: Well . .____.-._ Foundation ------ ---- Property Line ---------- SEEPAGE PIT [ ] Depth ---- ---------- -. Diameter ---------------- Number . --------- ----- Rock Filled Yes ❑ No ❑ Water Table Depth ------------------ .............................Rock Size -- - ----------------------- Distance to nearest: Well -____---------________________________Foundation ----- --------- --- Prop. Line ..--_._.__-.._.-..__-- REPAIR/ADDITION(Prey. Sanitation Permit# -------------------------------------------- Date ----------.-._-------------------) SepticTank (Specify Requirements) ................. ------------•------ ----_----------------------------------- ------------------- ------ ----------------------_---- Disposal Field (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 thet in the performa a of the work for which this permit is issued, I shall not employ any person in such manner as to becart ubject to or p n's olnpensatio laws of California." Signed trr- 41 �•+L / T B - - % �•- a...:�i� -...._._ itle . ....-. �l��L :Is.�1'. _....... - -- - - -- Y . - - owner( (If other than FOR DEPARTMENT USE ON Y 7�+ APPLICATION ACCEPTED BY - - �; DATE - -= - BUILDING PERMIT ISSUED ------------------------------------ ( ---- DATE - . ADDITIONALCOMMENTS ----------------------- ---------- -----------•---------- .............. .............................. ------- ---------•------------------- ----------- -- - ------- ------------------------------------------- ------------------------------------------------------------------------••---------------------------- --------------------- ---- - -------- - ------ - --------------------------------------------------------------------------------------------------- i.. ---------- ------- --------- - ------ - - ----------------------- ------------------- ----------------------------------- --------------------------- Final Inspection b ------------------------ -------------------------------- ---- r��.Date _ �`7C5 SAN JOAQUIN LOCAL HEALTH DIST CT E. H. 9 1-'68 Rev. 5M