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FOR OFFICE USE: / ;Z I I APPLICATION FOR SANITATION PERMIT ------------------------------- "1 751 (Complete in Triplicate) Permit No. __ e�-- --____---_----_----_-----------_---------------- This Permit Expires 1 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 existing Rules and Regulations: , JOB ADDRESS/LOCATION __,3 -----.--CENSUS TRACT -------------- �- _ Phone y/ � '.. .... . Owner's Name - ---�------- /� /. i� --------------------- Address -------�37-� ---------ou-_.4-A------c--G--�/-----R-p-------•--. City ��G�IJ.��? / Contractor's Name -------A_JZ1-1-___�Ll_Z4C5__ -------------------------------License # _02,,��=-��Phone Installation will serve: Residence �partment House❑ Commercial ❑Trailer Court ;❑ Motel ❑Other .------------------------------------------- Number of living units:---- Number of bedrooms -----/-_-__Garbage Grinder ______ Lot Size ___- G-_ l.. .... ....... Water Supply: Public System and name ------------- -__.-__--_-____________-__-_ Private EJCharacter of soil to a depth of 3 feet: Sand❑ Silt E] Clay eat E] Sandy Loam -E] Clay Clay Loa ;Q Hardpan ❑ Adobe ❑ Fill Material ------------ If yes,type ---------------------------- (Plot --- - -------------------- (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 pubic sewer is available within 200 feet,) �I oo PACKAGE TREATMENT [ ] SEPTIC TANK'{ ] Size----J'�_ k•_{ --Y sO--------------- Liquid Depth _-_---_ , Capacity Type k0t? Material---------------------- No, Compartments ---'Q-- :-•_.-:---- (� Distance to nearest: Well __-________________________________Foundation __,_t ------------prop. Line ............._V LEACHING LINE [ ] No. of Lines ------c------------- Length of each line____ Total Len_yi _� g ._____ __ th ,j�__�U............. 'D' Box -_1______ Type Filter Material _;�/�.Depth Filter Material -----/./ _____________________________ Distance to nearest: Well ------------------------ Foundation ----��--- ------- Property Line ----!............... SEEPAGE PIT [ ) Depth ____________________ Diameter ---------------- Number ----------------- --------- Rock Filled Yes ❑ No i❑ Water Table Depth --------------------- --------------------------Rock Size -------------------------------- Distance to nearest: Well ________________________________________Foundation -------------------- Prop. Line ...................... REPAIR/ADDITION(Prev. Sanitation Permit# ____________________________________________ Date ----------------------------------) SepticTank (Specify Requirements) --------------•-------------------------------------•----------------------•------ -•------------------------------------------------------- Disposalfield (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- 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 Signed -------14_ -------/%`f �y" E----------------------------------------- Owner BY ------- -------------------------------------------------------------------------------------------- Title ----------------------------------------------------------------------- (If other than owner) FOR DEPARTMENT USE PNLY APPLICATION ACCEPTED BY ---------------------------------- - 4 /' =?` DATE -----_----'�" -^T2..------. BUILDING PERMIT ISSUED --------------------------------------{�------- --------- ---- --------DATE ------------------------------------------- ADDITIONAL COMMENTS ------------------------------------ `--- - - ---------------------------------------- ------------------------------------------------------------- ------------------------------------------------------------------------------------------- -------------------------------------------------------------------------------------------------------- ------------------- ---------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------- ------------ ---------------------- --------=------- Final Inspection by; ---------------------------------- -----� - -- - Date ----- '�' --- - SAN JOAQUIN LOCAL HE fi DISTRICT E. H. 9 1-'68 Rev.5M �.�P'