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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT (Complete in Triplicate) Permit No. -�- --------------------------------------------------- This Permit Expires ] 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/LOCATION . /I � -- �_(G 12---fps--J ,I{-- -[-- ,j----q-_Ld_,_W_�-.__CENSUS TRACT -------------------------- Owner's Name ►-- -------Phone Address --------- -h- ---------------R-eG 1-� City --�----t�----------------------------------- ------ ------ 4 - '1 g 141 i --------------- --• J / Contractor's Name .--- 20,44 --- -----------------------------------License #R7/S: _3.9----- Phone 3 Installation will serve: Residence U A16'r-Iment House❑ Commercial ❑Trailer Court ❑ Motel ❑Other --------------------------------=----------- Number of living units:-----.-j--- Number of bedrooms --__-2_Garbage Grinder -Y-�-. Lot Size _25L_ -------------------- Water Supply: Public System and name --- -_-;-- Gs!�4-, � �--------------------------- -----------------------Private ❑ 'Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ s 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.) s NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,] PACKAGE TREATMENT [ SEPTIC TANK: Size-------- - - ------------ - Liquid Depth -------------- Capacity J-D--ems,_-_ Type - 44-_A_F7 Material- n- No. Compartments Z______________ Distance to nearest: Well ---------_'^� ' �G i -------------------------Foundation ----- ---------------- Prop. Line ----------- LEACHING LINE [X No. of Lines ------1---------------- Length of each line---J-00!------------------ Total Length �PJ�?_ ------------ 'D' Box !- ___ Type Filter Material �G�--_---Depth Filter Material -.-_fp_fl---__----------------------- i Distance to nearest: Well _-------`=------ Foundation _--.-/0_ --------- Property Line -!............... SEEPAGE PIT"[J Depth „)-5-------------- Diameter _- ----- Number Number __l._----.--.-------------- Rock Filled -Yes �o s V-0 Water Table Depth --------- ---------------------------------Rock Size ------ Distance to nearest: Well -----------------------------------------Foundation /67------- 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 1 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. Nome 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 -67 c. (If other than n n FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY -- i ---- --- -------------------------------------------------------------- DATE 11-_1T_J --------------------- BUILDING PERMIT ISSUED ------------- DATE ---------------------------------------•--- - --- ADDITIONAL COMMENTS ------------------------------------------------------------------------------- ------------------------------------------------------------------------- -------------------------------------------------------------- ----------------------------------------- ----------- ----------------------------------------- - --------------- -------------------------------------------------------------------- ----------- Final Inspection by: ---- ------------------------------------------------------ --------------Date -1-1- -�=!- _1_. SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M