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FOR OFFICE USE: C APPLICATION FOR SANITATION PERMIT _ 4 (Complete in Triplicate) Permit ido. --------------------- __-_- 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/LO ATION`.__.e _ --- - l�IV CENSUS TRACT Owner's Name _ '1U1 Q-----------RE------- -- ----------Phone ------------------- ------•--- ------ Address __� .y A V -5 - >i ----- L ��©�_ __. City --- ------------------------------------------•------ Contractor's Name R 4� P i' ------ �P'Suc_�==-------.License #2 -6a7r1_�__-'hone ----- t Installation will serve: Residence ❑Apartment House,❑ Commercial []Trailer Court i❑ Motel ❑ Other ---------------------------- -.� _—2-4/ 11� [J Lot Size nn Nurnber of living units:__- ____ -- Number of bedrooms _Garbage Grinder . _--___ +TCk_e-� -- Water Supply: Public System Land name --------- --------------- ------ ---------------------------------------------------------------------------Private Character of soil to a depth of'3'feet: Sand'[] i .hilt r ; lay,[f ;Peat❑ Sandy Loom ,0 Clay Loam .4 HardpandolS�'❑ `f]ij! Material __ _ If yes,type ----------------------------- (Plot plan, showing size of lot, Aocation'of system in relation to wells, building's;i.*'`'M&sf be placed on reverse side.) NEW-INSTALLATION: _(No septic tank or seepage permitted if public sewer is available-within 200 feet,) r PACKAGE TREATMENT 2[,.� { ] SEPTIC TANK' Size__- �_ __ t -------------- Liquid Depth _% - - -- --------------- Capacityyp -_TMaterial___�8(� , No. Compartments T =�-� p � Q Distance to nearest: Well -------50____"'r_----------Foundation __—0-=t'1-`.__-_ Prop. Line -S i -�-_ ,LEACHING LINE Y?-_�No. of Lines _ ---______---__ Length of each line---10p- -----------_ Total Length _ &V--------------- 'D' ---_____'D' BoxType Filter Material _ -("; Depth Filter Material -_----- __//-------------------------- Distance ---_ __ _____ __ Distance to nearest: Well _--__.5C�----------- Foundation _._ _- Property Line ------= ------------•-----•----- SEEPAGE PIT Depth -__- _-1.--.__ Diameter I -}^j"�--- _"mber .__�--- --_- Rock Filled Yes No ❑ 117 f Water Table Depth --------35--------------------------------Rock Size _�-- ?--------- Distance -Distance to nearest: Well -------- _--_____.________--.Foundation --149---------- Prop. Line ------- ... REPAIR/ADDITION{Prev. Sanitation Permit# -------------------------------------------- Date _______________________-_________� Septic Tank (Specify Requirements) ___________________--_____------_-----------__--_---__-- -_-----_ Disposal Field (Specify Requirements) �-- --------------------- ------------- ., -------- --------- --'---• ----------------------- ---------------------- - --------------- --------------------- ----- t ---------- --------------------------------------------------------------- • --------------------------------------- i---..-.----t-----------------------.--------- 5.-._..-",`_'i---'+="`t 1 -- (Draw existing and required addition on revers€.side) I hereby certify that I have prepared this application and that �thd,Vork will= be done in accordance with San Joaquin County Ordinances, State Laws, and Rules and Regulations'of;the San Jodquin Local Health District. Home owner or licen- sed agents signature certifies the following: t "I certify that in the performance of the work for.w>Wich this permit is issued, I shall not employ any person in such manner w as to become subject to Wo man- ' Compensation i-Iaws'o(California. - - ,r Signed "'It.: ----------------- Owner BY - ------ ---------- -------------- Title ---------------- ------------------------------------ (1 other than o er).' FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY - C ------- =' 4 1 i` �_`----------'--- ' 1� -- BUILDING PERMIT ISSUED -.-_- ----------------------- " ---=- ------ --�_. DATE ---- ------ ----•-�------------ ------ -------------------------------------------------------- ---- - -----:DATE-_----' --'-==�-_=-----=----=--_� � - ADDITIONAL COMMENTS ______________ r --------------------------------------- -------------- --------------------------------------- = - ,i - ------ ------ --------------------------------------------- -- - ---------------------- -- = - -------- - } Final Inspection by.__,- r � Y ----------------- ------------Date - -----.-------------- t✓'' r SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M