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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT f 9S� (Complete in Triplicate) Permit No: __7________________ --------------------------------------------------------- This Permit Expires 1 Year From Date Issued Date Issued __�=a-�'7.t� 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/LOCAT ON p Y.___- - -G --------------CENSUS T RACT ------------------.- ----- - � � _ ---------- - Phone ------------ Owner's Name --- � --------- _ O Address ---------7 Odd � 5-Vt/-A5 - Y ---- y ----- --------------- Contractor's Name ---Ar_ L1«_` � ��___..f-___5lV--------------------License ------ Phone ------------------- ---------- Installation will serve: Residence R1 Apartment House,E] Commercial ❑Trailer Court !❑ II Motel ❑Other ------------------------------------------- 9 Number of living units:_-_1____ Number of bedrooms --- ___.._..Garbage Grinder -_________ Lot Size _6,0- �"�vr Water Supply: Public System and name -----g z---kt__C`------------------------------------------------------------------------------•--Private ❑ Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ;❑ Hardpan ❑ Adobe I] 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.) 9i NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) N10 PACKAGE TREATMENT [ ] SEPTIC TANK,[ ] Size------------------------------------------------ Liquid Depth __________--.-_.._.____-. Capacity -------------------- Type -------------------- Material-------------------- No. Compartments ------- .............. 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 -------------------- ----------------------- Distance to nearest: Well ------------------------ Foundation ------------------------ Property Line ........................ SEEPAGE PIT [ ] Depth _________________ Diameter _______________ Number _________________________ Rock Filled Yes ❑ No 0 Water Table Depth ----------------------------- ----------- ......Rock Size --------------- ---------------- W Distance to nearest: Well ________________________________________Foundation _________________ Prop. Line ...................... .0i REPAIR/ADDITION(Prev. Sanitation Permit# ____________________________________________ Date ________-_____---_--__•-__________) Septic Tank (Specify Requirements) ------------------- ----------- --------- ----------------------------------•----- --- --- --------- •------ Disposal Field (Specify Requirements) -------_�_X__J A__X.6__________ e p Jg C'_________ Q� -----------------------sle-4t i e r- T-------- ------- ------------- ---------------- 14 -----19dYi M------• e!-----oX 4-----a--------S�----/ ------------------------------------------------------ ------------------------------- ---------------------------------- --------------------------------------- -- ------------------------------------------------------------------------------------------- (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, 1 shall not employ any person in such manner as to become subject to Workman's Compensation laws of California." Signed _-- _, _/V_ /f OIV 5�' -------------------------------- Owner BY ------- -- ----- -- ------------------------------•------------------------ Title ----------------------------------- ner FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ------- ---- -- ---------------------------------------------------------------------- DATE "+`' - ------------------- BUILDING PERMIT ISSUED --------- ------------------------------------------------------------------------------------------------DATE ------------- ----------------------------- ADDITIONALCOMMENTS ------------------------------------------------------------ -------------------------------------------------------------------=------------ -------------- ----------------------------------------------------------------------------------------------------------------------------------- ---------------------------------------------------------------------- ------------------------------------------------------------------- ------------------------------------------------- - -------- - - -------------------- Final Inspection by: ---------------------- - - <--- L ------------ Date . SAN JOAQUIN LOCAL HE H TRICT E. H. 9 1-'68 Rev. 5M w�