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FOR OFFICE USE: _ APPLICATION FOR SANITATION PF W --•-•---------- ------------------------------ ----- Permit No. {Complete in Triplicate} '-'TLfJ _------------------------------------------------------- This Permit Expires I Year From Date Issued 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 exi.sting Rules and Retdulations: JOB ADDRESS/LOCATION . /•q f9 / U�` CENSUS BRACT ------ -- Owner's Name --.. L-7~ /1&1fWU.. p? , /� 1,1 &V/-------••-----..Phone ,J6.�j�:- Address ---•-•-------------- ------------------------------ --•--- City ----------------------------------------------------- ------------- -------- Contractor's Name �/`[ L -------- L �/�(`'_.� _. `, - --------License #j_'.��.f5'` _J Phone --_ r Installation will serve: Residence ❑ Apartment House[] Commercial ❑Trailer Court ❑, Mote! ❑ Other _C.5�/ '1'_a_e.a ....... Number of living units:_-_'" -__ Number of bedrooms __-_`—__Garbage Grinder .. ------- Lot Size - ............. Water Supply: Public System and name ----------------I——---------•-;-• ----------------• ...............Private Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ ' Clay Loam Hardpan j] AdobeK 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 [ ] SEPTIC TANK Size./ -, ize. _ --------- Liquid Depth __//.................... Capacity."'241'ev_49t'_Type. �J� -Material G'�G� LyE No. Compartments Distance to nearest: Well -....1 _a---------------------Foundation _../G)............. Prop. Line __ ''d LEACHING LINT= X1 No. of Lines ____________ Length of each line--..�7s"_ __-_.-..--_ Total Length /__o... ........... 'D' Sox y ._. Type Filter Material Depth Filter Material _.............................. d Distance to nearest: Well __A90__-------- Foundation ...f-e.............. Property. Line ...� ............. SEEPAGE PIT Depth _ Diameter ,_. �l Number :� I❑ p �.5-----•----- ��-.._... ---------�-------------- Rock Filled Yes No Water Table Depth ........700_1...........................Rock Size _1-�-��•-�--��--- Distance to nearest: Well ------1_57722. e-----------------Foundation _1-t7............ Prop. Line ........... REPAIR/ADDITION(Prev, Sanitation Permit# -•----------------------------------- ----- Date ---_---------------•--------------] /\ Septic Tank (Specify Requirements) _... -- ------•----------------•--•---•-------------------------------•-----•------------------- -------...-/ DisposalField (Specify Requirements) -----------•------------------••------••-• ----------- ----_------------------------------------______-•----------------------------- ----------- ------------- --------•------------------------------------------•---•-------------------_---_---------------_------------------•--•---•--------------------------------------•-------- -----------------------...----• --------- ----------------------------------------- ----------------------------------------------- --------- ..........................•-•-••------- ---- 1 (Draw existing and required addition on reverse side) LJ 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 ° • 7 - Title .. -C�``��--•-------- ----..... r By ..-- - [ ---- ) --- --- ----- l If other than ow C� FOR DEPARTMENT USE ONLY J APPLICATION ACCEPTED BY -4------- Y --_-_r---_-_ -- --° - ----------------------------- --------------•----------------__..-•-------------- DATE -�1 z1..1�..�--•---------••-------- BUILDING PERMIT ISSUED --------- - -•--•--- .......... DATE --'----------------------------•-------•-- ADDITIONAL COMMENTS _-_.__--�- .--••---•-- •- `-----------------•---- ---------•--- - ------------------- •7 ............._.....-.... .... --•---------------------------------------------- ---- ------ Final Inspection by: ----- d L_... - -- ---..Date SAN' AQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M