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FOR OFFICE USE: "- A " - ' Y� PPLICATION FOR-SANITATION PERMIT --6�- ------- -`,�------------------ _ _ , t". 'Permit {Complete in Triplicate) Q -------------------------------------------------- F = t_ --------------------------------------------------------- This Permit Expires Year From Date Issued i Date Issued - ll - F 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: 1 -- JOB ADDRESS/LOCATION - Cl_'S� ____,--��_�1--_-_--— _4-----_-�-#`____��_� c :-__CENSUS TRACT -------------------------- } n -----Phone ------------------- Owner's Name ��- �-�--- ''�'�_l�-��-----•------------------------------ - -----�- ---- ----- ---.: ---- ----- ---------- Address � - �� / - °.1� `� 2 IV city --`-----�----- ---- - -- - ------------•------ V _ ----------------- ---- / Contractor's Name t 3 1 License# 9; 7 —Phone ��_�-__"- �P t , Installation will serve: Residence ❑Apartment e❑ lHousCommercial ❑Trailer Court ;❑ i Motel [)Other ------1---___�)r'�E-!__/-�------- Number of living units:_'__.!_____ Number of bedrooms .:_______Garbage Grinder ----- Lot Size'-f' �_ -_ �_ ---------------- } Water Supply: Public System and name -------------------------------------------------------------•----------------------------- ----------------- ----- •------------•------- nvate Character of soil to a depth of 3 feet: Sand'E] Silt❑ Ciay ❑ Peat❑ Sandy Loam ❑' 'Clay Loam ' Hardpan ❑ Adobe Fill Material/VO---- If yes, type _______,_____________________ k p (Plot plan, showing size of lot,'location of system in relation to- wells, buildings, etc.,.inust-,be placed on reverse side.) �V , NEW INSTALLATION:_'e. (No septic tank or seepage pit permitted if public ewer is available within 200 feet,) / PACKAGE TREATMENT![_] ,-SEPTVGTANKY Size____ _ ____ ' _______________-Liquid Depth - l ____-___,-.__- Capacity ---I,x.014__„__ Type _T� ___ Materia _y_tC- —No. Compartments __ Distance tol{nearest: Well ______ 1---------------------Foundation ---to------------- Prop. Line _�� ...... � .F LEACHING LINE No. of Lines ----------------------- a_5� ------54--------------- Total Length ___.. --------.-.._.._ - t - Lent of eac i Length 'D' Box r_}�,�___ Type Filter Material`), _:__Depth Filter Material _________ L Distance to nearest:,Well _________.___ Foundafn Q--------------- Property Line y 9 SEEPAGE PIT Oil Depth _,�_.�?_._____ Diameter ��___._ Number _------------------ Rock Filled Yes�' No i❑ ------------------------------------Rock Size -------- 1 Distance to nearest: Well ---- ___0____1____________________Foundation Prop. Line REPAIRJADDITION(Prev. Sanitation Permit# -------------------------------------------- _______________________________-_--__'--.»'Date _--- �---- - _ -- ------------------1 Septic Tank (Specify Requirements) ) -' ----------------------------------------------------=_, f 1 �Disposali, Field (Specify,Requirements) ----------------------------------------------L '--------- ----------------------------------------- ------------ wt., F , '—-,(Draw existing and required addition on reverse side) I hereby certify that I have prepared thisapplication, and that the work will be done in accordance with San Joaquin County Ordinances, State Laws, and/Rules and Regulations of the. Sam,doaquin 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 f as to become subject to Workman's Compensation laws of California.” t Signed ----------------------------------------------------- ---------------------;--t-------------'� Owner...^'. _ t By _----------- i -------- - ` � Title ------ _ ---- --------------- a - ------------- (If other than owned• / R ' f F • FOR .DEPARTMENT USE,.�ONLY: ' APPLICATION ACCEPTED BY ^^' ----------------------------------------------------, ----------------------- . DATE BUILDING PERMIT ISSUED .__4. --- -.._ ------ ---------------------------- -- --- - - ---------;------------= --------�----DATE -------------•----------------------------- ADDITIONALCOMMENTS --------- -------------------------------------------- '---------`-----------`------------- ------------------------------------------ -------- --------------------------------------------------------------------------------------------------------------------'---------------------------------------------------------------------------- ---------------------•------- --------- ---------------------------------- ------------------------------------ Final Inspection b - --- -----------------------Date --- ' _ro---------------- - ---- ----- - �- SAN -- - JOAQUIN LOCAL HEALTH DISTRICT ; + ,� E. H. 9 1-'68 Rev. 5M. y Y I