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FOR OFFICE USE: ;2 L-00b 5�1-e Vf A ""('"`0"( (� C/ 7V ----------------------------------,----------------I- APPLICATION FOR SANITATION PERMIT Permit No. _----•-- -- Z. (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 complian'c'e with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION .__ b iL ____ CSS_SKr__� �;__ -�3-_R�____laV_---CENSUS TRACT 9 _�____. F" 4 Owner's Name .---------15AR_3'R14------i4,A_TF1ffA"P------------------------->---------------_- ----------------- -Phone ------------------------------------ �l , Address ---------------1-3-1------ IU----A1.1e-------�U^7UG_�3k�L'2,,-- /�l-l�_. C-i+q -------------------------------- ------------------------------------------- Contractor's Name AT-Cfa_aw--y__ ----�___.License # -�e- A-6-9-S-0--- Phone - Installation hone _Installation will serve: Residence KApartment House❑ Commercial ❑Trailer Court ;❑ t Motel ❑Other ------------------- ---------_----------- A�,, �p Number of living units:----- ____ Number of bedrooms -----t-----Garbage Grinder 1%------ Lot Size .UCa_____Xf Water Supply: Public System and name ---------------------- ------------------------------------"--------- ------Private 21— � Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam;❑ Hardpan ❑ Adobe'Fill Material _,Ab--- 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,) I r PACKAGE TREATMENT [ ] SEPTIC TANK 64 Size_ _qal__________________________ Liquid Depth ...9 ti---------------- Capacity Type"CIMioIT*,- Material__C1 _ 4"; No. Compartments _.. a Distance to nearest: Well ------------------------------------Foundation ____cf________ Prop. Line ........... LEACHING LINE ( ] No. of Lines _________a_______-___ Length of each line____ _______________ Total Length ------ _0---___--_--_-__ 'D' Box iPS_____ Type Filter Material .: ___Depth Filter Material ______jell............................. Distance to nearest: Well ___'____ __________ Foundation --------------- Property Line ----a.................. SEEPAGE PIT [ ] Depth _ ____ Diameter ---------------- Number ---------------------------- Rock Filled Yes '❑ No i❑ Q WaterTable 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." Signed -------------------------------------------------------------------- ------ ------------------- Owner By --------------------------------------------------------- ---------------------- Title ------------------------------------------------------------ (If other than owner) ,FOR DE ARTMEN SE ONLY APPLICATION ACCEPTED _" ___ ___ ___ ____ _______ --- --- DATE ____� �____' BUILDING PERMIT ISSUE - - DATE ADDITIONALCOMMEN ------ ---------------------------------------------------------- --------------------------------------------------•-------------------------- ---- -------------- ----- -- ----- "----- - - --- __- - ---------- ------------------------------------------------------------ _ ----------- = Final Inspection -- -- ---------------------------------------------------------------------------Date - ,z " — --------- ----------- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M