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� x r .- FOR OFFICE 'USE: . ._ APISLICATIbN FOR SANITATION PERMIT -------------------------------------------------------- Permit No: - - =--- - --cl (Complete in Triplicate) - `- --- - Date Issued This Permit Expires 1 Year From Date Issued _OS Application is herebymade 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. ` 9 ander xisting Rules and Regulations: JOB ADDRESS/LOCATION N4R-A--_ -C�--4-' --`14e------ Y� '� ��`P CENSUS TRACT -s= ��-----------• Owner's Name -.V�. f----------- 1 —------------------ ----------------------_---------------- ---------------------Phone Cit ------ QR�YT"usv jrl/ Address -------- ©. - O X-----�7/-------------------- - - Y Contractor's Name ---- -------------------------------------------------------------License # ---------:-------------- Phone `.79 `--- S2o Installation will serve: Residence ❑ Apartment House[] Commercial ❑Trailer Court Motel ❑Other -------------------------------------------- .�, Number of bedrooms -_____- __Garbo a Grinder __-_- Lot Size Number of living units:_--. 9 �/ Water Supply: Public System and name ------- ------------------------------------------------------ -------- ---------------------------------------Private Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay X Peat ❑ Sandy Loam ❑ Clay Loam ❑ Hardpan ❑ Adobe ❑ Fill Material ------------ If yes,type ---------------------------- Ci� (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 flank or seepage pit permitted if public sewer is available within 200 feet,) V� PACKAGE TREATMENT JK SEPTIC TANK![ ) Size----------------------------------- Liquid Depth -----------•--------,---- 1�`� Capacity -------------------- Type :----------- ----- Material-------- ----------- No. Compartments ----------------------- Distance - ---•----------•-----Distance to nearest: Well ------------------------------------Foundation ---------------------- Prop. Line ---------------------- LEACHING LINE [ ] No. of Lines ------------------------ Length of each line---------------------------- Total Length ---------------------------- 'D' Box ----- ------ Type Filter Material ---------------------Depth Filter Material -----------------,------------------•-•----- Property Line -----•--------------••-- Distance to nearest: Well ------------------------ Foundation ------ ------ p Y SEEPAGE PIT [ ] Depth --------- ------ Diameter ---------------- Number - ------------------------- Rack Filled Yes ❑ No I❑ Water Table Depth ----------------- ------------------------------Rock Size ------------- =-=----------- ., Distance to nearest: Well ----------------------------------------Foundation -------------------- Prop. Line -:-.------------------ REPAIR/ADDITION(Prev. Sanitation Permit# ------------f------------------------------ Date -------.------------------------•--) �� e ` 1 Septic Tank (Specify Requirements) ------------ p_X/_OOLT-G�.2 f C 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- 4 sed agents signature certifies the following: "1 certify that in the performance of the work for which this permit is issued, I shalt not employ any person in such manner as to become object to Workman's Compensation laws of California." ��. SignedJ -24 6--<tX- �` ��/ ------------------------------------- Owner Title ---------- ------- -------------------- (If other than owner) F R DEPARTMENT USE ONLY 1 APPLICATION ACCEPTED . --- = DATE . - BUILDING PERMIT ISSUED ---- --------- --------- -- DATE ---------------------------- ADDITIONALCOMMENTS ----------------------------------- --------------------------------------------- -------------------------- -------------- -------------------------------------------------------------------•--------------------------------- - --- --------- f Final Inspection -------- ------•---------- --•----- - -----------------------------.Date ------------------------- --- - --- SAN JOAQUIN LOCAL HEALTH DISTRICT' r � E. H. 9 1-'68 Rev.-.5M