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FOR OFFICE USE: APPLICATION FOR SANITATIOW PERMIT 1 .��iaPermit No. ---�-7----333 � --- -----•-------------------- (Complete in Triplicate) _ r/ -------------------------------- d 7r Date Issued ._ ___�_ ______._ --------------------------------------------- - 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 i described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION _�I_ -InQ----:- _._ 2s� _ r`.t2ci�--CENSUS TRACT -------------------------- Owner's Name _C1-o- h � snl--V --------------------------------- Phanef "bI� _ = L� - t�&----------------- City i �'-�2 Address _��_��,.-�f7� - - -------------------------- 121, ------------------------ _ 12 ��' ------.License # �_ Phone Contractor's Name - - . Installation will serve: Residence F1Apartment House❑ Commercial :[]Trailer Court Motel ❑Other -------------------------------------------- .lam� - Number of living units------------- Number of bedrooms ____________Garba_ge Grinder ------------ Lot Size ----------________ -�_ --- Water Supply: Public System and name --------------------- -----------------------------------Private Character of soil to a depth of 3 feet.. Sand'[; Silt❑ Clay ❑ Peat❑ Sandy Loam .ED Clay Loam .E] 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.) V` NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is avail le within 200 feet,] PACKAGE TREATMENT [ I SEPTIC TANK f ] Size-------- ---------------------------- --------- Liquid Depth ---------------------.----- Ca acit _ Type -------------------- aterial----------------- ---- No. Compartments ----------------- Distance to nearest: Well ------------- ----- --- --------Foundat' n ______________________ Prop. Line ------------- ------- LEACHING LINE [ ] No. of Lines ----------------- ------- Length f each line--------- ----------------- Total Length ____________________________ 'D' Box ---....----- Type Filter Mater' I --------------------De Filter Material ----------------------------------------- -- Distance to nearest. Well --------- -------------- Foundati ------------------------ Property Line. ------------------------ SEEPAGE PIT [ ] Depth --- Diamete ________________ Num r ---------------------------- Rock Filled Yes ❑ No i❑ Water Table Depth ---------- --------- -----Rock Size -------------- ----•------------ Distance to nearest: Well ___-,._-_Foundation __________________ Prop. Line ...................... REPAIR/ADDITION(Prev. Sanitation Permit# --- ---------------------------- ---------- Date ----------------------------------) Septic Tank (Specify Requirements) ----------------------- --- ----------------------------- -------------------- ---------�------------------•-- ----------------------- s af[z SCJ------J--�S------�� 'r��------— ---------- Dis�osa�11__ field (Specify Requirements) __-___�--------------•----- f-- -� -� ---- ------------------------ -------------- -------------------------------------------------------------- - ------------------------------------------------------------------------------ ------------------------------------ ---- (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." I Owner s Signed - -- -- ---- - ` ------------------ $Y -- - -------- Title ------- - --------------- -------------------- ----------------------- (If other than ow r] FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY -- ---- s------; -- - ------------------------------------------------------ DATE ---- ~7 ......------ BUILDING PERMIT ISSUED - ------------------------- -----------DATE ------------------------------------------- ------------------------ ADDITIONAL COMMENTS ---------------------- ------------ ------------- ------------- ------------------------------------------------------------------------------------ --------- ----------------------------------- - ----------------------------------------------------------- ------------- -------------------------- ---------------------------- ----- ----------- - y� .,O - Final Inspection b ll --�-' � � Dafie ��' ' SAN JOAQUIN LOCAL HEALTH DISTRICT 00 F H 9 1-'68 Rev. 5M