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FQR OFFICE USE: APPLICATION FOR SANITATION PERMIT # . ,�. Permit No. ,,, {Complete in Triplicate) / --------- �. :r_�----------------------------- _____________________________-._._______________________ This Permit Expires ] Year From Date Issued Date Issued .._fU'_ 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/LOCATION - 5 _�___�._ f? A _______________________ ��'- -1�-i9 ___ _ ______________CENSUS TRACT -- -- -- --A------------ -------------------------- Owner's Name ----- � e`j '------ 411-g-r---------------------------------------------------------------------Phone Address /? bw--------------------------. City ---5-1-'10C-k-fiV.r�------ci3!X------- -------- Contractor's Name ---_ ------//L�* _k?_'--------------------------License #,7,6-7177---- Phone 4.6_x`3 a Installation will serve: Residence tment House❑ Commercial :❑Trailer Court Motel ❑ Other -------------------------------------------- --------------,---- Number of living units------ Number of bedrooms _ _____Garbage Grinder _![gip__ Lot Size __�5-- - 60 - Water Supply: Public System and name ----- _ />_-S'-----C.{ ] ------•---------------------------------------------------Private ❑ Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ Hardpan ❑ Adobe Gill 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'[ ] Size------------------------------------------------ Liquid Depth -------------------------- Capacity -------------------- Type -------------------- Material----------------------- No. Compartments Distance to nearest: Well ------------------------------------Foundation ---------------------- Prop. Line --------- ------------ LEACHING LINE lo. of Lines __i_-____________ Length of each line_________�_._____ Total Length ----- ------ ------ 'D' Box .__ __ Type Filter Material __Rb-'k----Depth Filter Material ________ ________________________ Distance to nearest: Well -----I_�®-________ Foundation -----3-6)--- Property Line -- .!_.--...... / F SEEPAGE PIT [� Depth _. S'___-_-.-- Diameter _ _3_______ Number --------- __________ Rock Filled Yes ��No.❑ t /f Water Table Depth --------------59-e------------------------ -Rock Size --------'Z--------------------- / Distance to nearest: Well - _a _Twm_ ______Foundation _____7_m____..-__ Prop. Line _____�b__ _ REPAIR/ADDITION{Prev. Sanitation Permit# ------------------------------------------- Date __________________. .............. Septic Tank (Specify Requirements) -------------------- ) Disposal Field (Specify Requirements) __ 4_.5'--- ------�-0------ - -----------p ;_4 -----11 E?--e------ -�Z- -------•------ -- -----------------r------ ---- J - ...........ac-- //- x1 _ _lam --- - ------------------------------------------------------------------- (Draw existing and required addition 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." Signed - - Owner ------------ B Title - N (If other than-owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY __ ------ --- --------- � 1_1__ -------- ------------------------ DAT . ^-�-----� BUILDINGPERMIT ISSUED ----- ---------------------------------------------------------------------------------------------------DATE -- ---------- ----------------------------- ADDITIONAL COMMENTS --------------------------- ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- --------------------------------------------------------- ------------ -------------------- ------------------------ ------Final Ins ection b - ----------- -- --- ------- P -y- --------- Fina ---------rr------- - - ------ ---- ----- - - ------ --- -----------------------------Date . --------------------�-/--- SAN JOAQUID6 LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M