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a ' yFOR OFFICE USE: I APPLICATION FOR SANITATION PERMIT Permit No: x - iComplete in-Triplicate)°-- ---� ------------------------------ - - ------------- This Permit Expires 1 Year From Date Issued Date Issued _470-6--71-1. Application is hereby made to the San Joaquin Local Health District for a per 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/LOCATJQN --------7--_ �Gt}Lz ' -------------- I'-�li- -'r-- ------ /.._CENSUS TRACT . 5--��- --------- Owner's Name -=-----V_C_[.i4- ------t---C11_�-yrt�r��_� Phone - Address -`� . Q ------------ ------------ City -------------------------- -------------------------------•--•---•-- 1! U Contractor's Name --------- �6�----------------------------------------------------------------License # --------------- -------- -------- F-------- Phone -------------------------_- Installation will serve: Residence ❑ Apartment House'❑ Commercial :❑Trailer Court Ery Motel ❑ Other -------------------------------------- Number of living units..]-______ Number of bedrooms ------- Grinder ------------ Lot size ------------- Water Supply: Public System and name --- �� /t-----------------------------------------------------------------Pr-vate ❑ � Character of soil to a depth of 3 feet Sand' Silt❑ Gay E] Peat E] Sandy Loam ❑ Clay Loam , i Hardpan ❑ Adobe'E] 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 seep pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK[ Size- ---------------------------------------------- Liquid Depth ______ �.-:----- i - A - - Capacity,./2_C249________ Type � __�_ Material.44,W),15-Al No. Compartments -.__ � ! ---- tance-'to nearest:Well -----,.I— ------------------Foundation __/ '______-----_ Prop. Line _/ - LEACHING LINE [ No._of Lines _ .""_____"`_ Length of each' line_-__-��"` g Total Length ------ /-.--------- Vs, : ..'D' Boz __ Type Filter Materials_,-_Depth Filter Material _---__ _____________---------- Distance to ii nearest:'well-; __--------- Foundation ------------ Property Property Line Z___ ra: Grp �- x _______________ Rock Filled Yes Na SEEPAGE PIT [ ] p Y 6iameter Number ____- �'�•, Water Table Depth ---.-------Rock Size -------------------------- Distance to nearest: Well -----------------------------------------Foundation---------------------- Prop. Line -----.-..-______-___._ REPAIR/ADDITION(Prev,�,Sanitationl.Permit# -------------------------------------------- Date ---------_--------------------------1 E! E Septic Tank (Specify Requirements) ---:-------------------------------•---------- - - ---------------------=• --------- --------------------------------------------------- i -------------------..----------- --• --------- DisposalField (Specify !Requirements) ----------------------------------------------------------------- ------------------------------------------------I--------------- iI I ---------------------------- ----------- ------------ ---------------------- -------------------- ------------------------------------------------- --------- ------------ x` '------------- '--------------------------------------------------------------------- -------- . `,(Draw existing and requiredaddition on reverse side) I hereby certify that 14 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 icrtifies 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 -= -_ --Y� P�C�•--: Owner �" ---- - -- —�- -— By ---------------- --------------I I---------------- ------t--------=----------'.-- Title ----:------------ ----- ------------------------------------------ (If other than owner-)- 1 t•^_FOR-DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--------- --� --------------' 2- --7-1-------- -"-- --` - ---•----------------------------------- � DATE ------�-�--- , BUILDINGPERMIT ISSUED ----------------------------------------------------------------------------------------------------------DATE ----------------------------------------- ADDITIONALCOMMENTS ---------------------------------------------------------------------------------------------------------------------------------- --------------------------- ------------------------------------------------------------------------------------------------------------------------------ --------------------------- ------- ---------------•------------------------•-------- ' ._ 1- --------------------- -------------------- Final Inspection b "" Date __._-1-_ ---- --------------- --------------- --------- --------------------------------- ------------ - p y- 7 SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. SM