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a3 0 33 '51� -D'a r! FOR OFFICE USE: << APPLICATION FOR SANITATION PERMIT -----------------;►------------------------------- LF-1k No. (Complete in Triplicate) ••� ------------------ ----------- --------------------------- 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/LOCATIONZ(;7---O`-,2,64/-.3_-__J'Alc7aAC.nw-'awRU ._ei'Va-__.__-----__----CENSUS TRACT -------------------------- 1 `�' Owner's Name --�'/-�t.�----�(�7��----------------------------------------------------------------------�-------------------Phone �- ..... Address ---- --------------------------------I------------------------------------------------. City _ ? --------------------------------------------------------- Contractor's Name -Ike—J------ __________________________________License #1,?P--fT3-___ Phone Installation will serve: Residence.]Apartment House❑ Commercial ❑Trailer Court i❑ Motel ❑Other -------------------------------------------- Number of living units:---j------ Number of bedrooms ---/-----_Garbage Grinder W-V-_____ Lot Size.40.7-_t' -r______________ Water Supply: Public System and name ---------------------- ----------------------------------------------------------------------------------------Private 0 Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam;T Hardpan ❑ Adobe ❑ 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.) NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANKX Size__9__ 1Vi','efy'_'_.____-_--___-___-__ Liquid Depth _---________•-•_- Capacity/ ---.__ Typef9-� r�-__ MateriaL�Q �-- No. Compartments �................. --Irl Distance to nearest: Well —_--------------Foundation ____�- !--________ Prop. Line __ ..._`......... i LEACHING LINE (A No. of Lines -___�__-_-____-___ Length of each line______ _______________ Total Length ,_ ............... 'D' Box y� t/ /� Type Filter Material ��-fC_____Depth Filter Material __��___________________________________ c Distance to nearest: Well =_. __ _D Property .............. .________ Foundation �___________________ Pro er Line SEEPAGE PIT [ ] Depth -------------------- Diameter ________________ Number ---------------------------- Rock Filled Yes 0 No 0 Q Water Table Depth ------------------------------------------------Rock Size -------------------------------- Distance to nearest: Well ----------------------------------------Foundation _________--._______ Prop. Line __•-__--•-..______---_ REPAIR/ADDITION(Prev. Sanitation Permits# ____________________________________________ 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 t e performance of the work for which this permit is issued, 1 shall not employ any person in such manner as to become su ect t or an's Compensation laws of California." Signed ....... - ---- ----1-------------- ------------------ ------------------ Owner BY ----------- --------- ------------------------------------------------------ ------------------------ Title ------------------------------------------------------------------------ (If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY �'t - -- ------------------------- ----------------------------- ------------------ DATE --- j �'------------------ BUILDING PERMIT ISSUED -----------------•----------------------------------------=--------------DATE -------- ----------------- -------------- ADDITIONALCOMMENTS ----------------------------------------------------------------------------------------------------------------------------------- --------• ------------- ------------------------- ------------------------------------- ---------------------------------------------------------------- ------- ----- ------- Final Inspection by ------ ----------- -- -------- / Date -��-h= SAN JOAQUIN LOCAL HEALTH TRICT E.-H. 9 1-'68 Rev.