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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ----------------- (o �O ,. Permit No. 6._ (Complete in Triplicate) ...............................:............------------- This Permit Expires 1 Year From Date Issued Date Issued ./_-15f_. 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/C�TIONHAS-59P/V...-_�...ZA1r 7?,5rA. .7' -- .,,,+ ..........CENSUS TRACT .......................... Owner's Name .l7- -, /4G_T��------------------------------------ ------•-------- ----------Phone ......... .................... Address -------------- !4 C -.t¢11 --------------------------- City ------------ Contractor's Name ------PA__ _A-----4A......so_nt.s--._INC-.License #140-5Il.....--- Phone Aoki r07---.- Installation will serve: Residence ❑Apartment House❑ Commercial Wrailer Court ;❑ Motel ❑ Other ----------------------------- ------------- Number of living units:--Q.----- Number of bedrooms -Q......Garbage Grinder Q------ Lot Size .. _G — Water Supply: Public System and name ------------------------------------_ -------------------------------------------- ----------- -----PrivateK Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat❑ . Sandy Loam ❑ Clay Loam Hardpan ❑ Adobe ❑ Fill Material ............ If yes, type ............................ (Plot plan, showing size of lot„'vocation of' s.stera_in relation to wells, buildings, etc. must be placed on reverse side.) LV NEW INSTALLATION: (No sept`c tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ ] SEFV' IC TANK'_ Size.._4-X.......................S. ------ Liquid Depth 6-1-4................. Capacityl.D�QQ_ Type ....... ...... .. Material.. No. Compartments�Z.�_._._...._.._- 42. �z-. J� Distance to nearest: Well -1-----------_-------------Foundation Prop. Line�.Q..'�._.._._ .ZrO.......... c c LEACHING LINE No. of L nes ..-.. ... . Length of each line-. 50-9 50- Total Length QQ. 'D' Box r ._.. Type Filter Material .2.11 - K._Depth Filter Materia) _ .%----------------------- _7 _..____.._..........._7 C Distance 4o nearest: Well .�--� ___.___..._ Foundation ....... Property Line .................. SEEPAGE PIT [ ) Depth .. ----------------_ Diameter ................ Number - ----- ..---- ----.__._ Rock Filled Yes ❑ No i❑ Water Table Depth ----- -------- --------------- -----------------Rock Size - ------------ ------------ -- Distance to nearest: Well ........................................Foundation .................... Prop. Line ...................... REPAIR/ADDITION(Prev. Sanitation Permit# ............................................ Date .................................. Septic Tank (Specify Requirements) ---- --- -----------------------------_-------------------------------------•-------- ------- ........ -•------------- ----- ------ Disposal Field (Specify Requirements) ................................. __....._.. ............... --------------------------------- -- - ------- - --- -- - -------- ---------------------- ---------------- -------- .....------- ------- -- -- - ---- . - . . .... --------........ --------- ------------- ----- -- ------------- - ----------------- -- - ----- -------------- --------- ----- (Draw existing and required 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 pgrformance of the work for which this permit is issued, I shall not employ any person in such manner as to becom s lect to Work 's Compensation laws of California." Signed -- - ------ ... -- ----- ------ Owner BY t,�.L.0 .. Z-�_ --- Title . . .. �other han owner) FOR DEPARTM T ONLY -- - _ 24 APPLICATION ACCEPTED BY _-- - DATE ... 69-.6 BUILDING PERMIT ISSUED .- --- - - -------.----- ---- -- ----- DATE - ADDITIONAL COMMENTS ------- ---- ------- -------------- -.... --------------- ----------------------- -------- .......... -------------- - ---------------.......---- ---- -- .....---... . --- -------- . ---- . ....._..... ...... -- ----------------------------------------------------------------------- --- ------------- ------------ - ----- --- •---------------------- -------- ----- ------ - --------- -- ------------ ----------- --------- -------------------- - Final Inspection b �. L�- « _.Date p y: ._ - - . .. 1. ).. _. SAN JOAQUI LOCAL EALTN DIJiRICT I E. H. 9 1-'6B Rev. 5M