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I FOR OFFICE USE' k� ... APPLICATION FOR SANITATION PERMIT �. -- -------------------------------- (Complete in TriPermit No. Triplicate] Permit ` -------- ------------------------------------ ----------------_---------------------------___-------- This Permit Expires#l...Ycaar From Date Issued Date Issuedi 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 . -,-LCCA- A" /o------]�>d---------------------------------i------------ --CENSUS TRACT ----- -------------------- 1 Owner's Name ---f1-f ---- ----�/4 7 +� --------------------- - --•------------ Address ---�~a7------: A_,Jo--------/-Z_d-_.Y_ft_ ri�- tri City ------------ ------------------------ --- Contractor's Name __ .L__... ------------------------------------------------------- -----License # _y.c .� Phoned- - -- � -� Installation will serve: Residence [Z Apartment House�❑ Commercial :❑Trailer Court E? r Motel ❑Other -- -- ------------------------------------- Number of living units:.___/___ __ Number of`'bedrooms ._Garba"ge Grinder ------ ----- Lot Size ___/'. _G'1z_`�________________ s ... I Water Supply: Public System and name __________________el __"_"__________-Private J Character of soil to a depth' of 3 feet: Sand❑ Silt❑ Clay Li 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,) Gj PACKAGE TREATMENT [ ] SEPTIC TANK'[ ] Size______'�X_16e ________ ______ ________ Liquid Depth ______-_.___________,_____ (^} Capacity Type ------- -- - Material. ----- - No. Compartments I------------= Distance to nearest: Well ------- ---------------------------Foundat on --------------------- Prop. Liir•.q ---------------7------ LEACHING LINE f F[ j No. of Lines --�--------------- -- Le 6th of each line------- ---.___-._ Total Length ------•-----_------•----__-- D' Box -____:____-- Type Filter Ma rial ____________________Depth Iter Material ----- --------------------- Distance to nearest: Well _________ __________ Foundation __-_. Property Line __________ ........ SEEPAGE PIT [ ] Depth ------I-------------- Diameter ---------_,_-- Number --------- ------------------ Rock Filled Yes ❑ No C] Water Table Depth _________. _ =-----------------Rock Si Distance to nearest: Well ________ ------------------------------Found ion _._____.____.____ Prop. Line ________-______...__.- REPAIR/ADDITION(Prev. Sanitation Permit# ______________ __________._-_---- Date __ ______________-._____________) F SepticTank (Specify Requirements) -------- --------------- ---------------------------------------- --------------•------------------------..__ ----------------------------- t I 1 Disposal Field (Specify Requirements) -------- ---------kd------+/-- f`------ �q -------- -ice✓ 1. --------- ------/ T` ,m ------------------- - ---- - ---------------------------------------------------------------------------------------------- (Draw existingand required q 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, it shall not employ any person in such manner as to become subject to Workman's Compensation laws of California." Signed �j Owner BY -------- - - ----- Cf ` Title ---------L--------- ----------------------------------- (If other than ownery � � ' FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ! F5)V[ -- ------------------=----------- DATE . j r � ate' ---------- BUILDING PERMIT ISSUED _(///-___ __DATE ____________ _____________________________ ADDITIONALCOMMENTS -------------------------------------------------------------------------------------------------------------------------------=--------------------------- ------------------------------------- ---------------- ------- ------- - ------ ------------- - -------------------------------------------------------------------------------- ----------------------=------------------------------- ---------- --------- ------------- ------ -- ---- Final Inspection b .Date -- -----_ -- - ----=- ---- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M