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Itn JL: S /f APPLICATION FOR SANITATION PERMIT _ -••---. . ................... Permit No. (Complete in Triplicate) - -------------------- ------------------ ' 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 described. This application ,is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LC►CATIONq_ r — CENSUS TRACT Owner's Name ,,/��j - . ve / 11/-C/I�l �� T�L �..R��n�-----�---"-------- -------- -- ---Phone �,S..a�S� . Address ----------- �3a.� r A�I;f¢ /� = ��/?K,:;ex ........ ------ City --------------------- ••- --•-------•---------- Contractor's Name .__V-CZ/!!J_�rC/. ----...--•-- ..............License* �------- Phone ---------------------------••- Installation will serve: Residence ❑Apartment House❑ Commercial:[:)Trailer Court Motel ❑ Other ..__. ___ -. %_" , -- - - - - - -------------- % Number of living units:___... Number of bedrooms �_G ~ '�-� � ___��. -._.Garbage Grinder ..�-__ Lot Size .._......... ............._..'�KsaC, Water Supply: Public System and nameT�:Z k -jea r' -_ 6c yam/ private ❑ Character of soil to a depth of 3 feet: Sand ❑� Silt{]' Clay-F] Peat( Sandy Loam ❑ Clay Loam ❑ Hardpan [I) Adobe Fil FMaterial= ..._ If yes,type ____________________________ 1 (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,J/ _� PACKAGE TREATMENT X SEPTIC TANK:[ ] �� Size--'S-�rS..X 4_ -_ 17 Liquid Depth ..../i� ._.___.___,_-_ ` / F Capacity/.• � / g Type : �__________ _____ Material._ -. _ No. Compartments __. ----- Distance to nearest: Well ____. �J__��I�Cr -..._._.Foundation ../Q��...._ Prop. Line -�{:� i y ---- .-- LEACHING LINE No. of Lines __---.. ._..._.-._._._ Length of each fine-- - -.�_�-]t�-A-.. Total Length : - 'D' Box // -._ Type Filter MaterialIF90 pth Filter Material _..___� .......... ..... I i ,11IJ ( .V�.. ,0---------- - Distance to nearest: Well .... �._ -aliGF__... Foundation �l�_�_+!US. Property Line s �� ________ SEEPAGE PIT [ J Depth Diameter ................ Number - Rock Filled YJS'0 No 1] Water Table Depth ------•------------------=t.....,r. ........_.Rock Siie ---- --- I , i Distance to nearest: Well ...__..._�'.._.___.�:-...........r_-----Foundation __?_______________ Prop. Line-._.._____._.._____ REPAIR/ADDITION(Prev. Sanitation Permit# ............:....::....:...�_._..: ____- :Date ___. ...... �. �+ `"...........................f ! e i Septic Tank (Specify Requirements) --------------- --------- = -- - sem. ------------------• -...., =--------------.... Disposal Field (Specify Requirements) ........... -• ------ --------- ............... - ------------ ---------- ............................................. --------------- ................... ----- ----I-------- ------------ ------------- - - _ Draw ezisting'and requiFeci addition on reverse side) f •- 1 hereby certify that I have prepared this application and that the'** will be done in accordance with San" Joaquin; + County Ordinances, State Laws, anb-Rules,and Regulations of tK Son Joaquin local Health District, Home owner or iicen- `' I sed agents signature certifies the following: "I certify that in the performance of the work;for which thif?permitJi—,wedt,'1 shall not,employ,6ny person.In such mpnner as to become subject to Workman's Compensction laws of California." 1' y ;. Signed - .._.. Owner l _ 1_ By ------------ --- --------- �' ""^� - Title _.. _ f w • --- . .--•- - -------------- --- (If he�owner" :¢FOR.DEPAi1TMENT USE ONLY APPLICATION ACCEPTED BY-- ----- -------- r er 1h . wG1ld/�fl ,�L -------------------- DATE__ - .�y ....---------- BUILDING PERMIT ISSUED .__ ----- - c _ _ ADDITIONAL COMMENTS :TE otd '^ ..:DATF- - = ...........................................r+... a. +v -- -------- ... --------------- .................... ....................... �: - in - ion y. - ----- -•----- -------------------••------•-s•--•-•• -----•-- ►/��t\r1' _ Final Inspection by: .: ,� r Date -~- - ------------- -- - SAN JOAQUIN- LOCAL.;HEALTH iDISTRICT E. H. 9 1-'68 Rev. 5Mf