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- FOR OFFICE USE: -� _. APPLICATION FOR SANITATION PERMIT A - --------------• - Permit No. �-- (Complete in Triplicate) 20 ------------_-_------- This Permit Expires f Year From Date Issued Date Issued _ .�_3__.. 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 = - --C 1 ��. .��- _f�� "CENSUS`TRACT -------------- •-•--- JOB ADDRESS/LOCATION .____ __ � thG=:a_y _ ___ y` ? . Owner's Name ---- -----,.s /_�lfi ��✓----------_----------------- ---------------------------------------------------- J - -�----f-- Address ------------ �--- -- ------------------------•--. City ----------------------------------------- ---------------------------------- Contractor's Name -,.______l__= � ---------------ri==t,__=License # ice;-��'f4z��'--- Phone Installation will serve: Residence ❑ Apartment House❑ Commercial ❑Trailer Court ,,E] t Motel 0 Other..--.---= k---------------------------- Number -------------------------Number of living units_____________ Number of bedrooms ------------Gorbage Grinder ------------ Lot Size ---------i----------------------------------- Water __ ____'____________________________--- Water Supply: Public System and name ------------------------------------'----------------------------------------------------------------- --------Private ❑ Character of soil to a depth of 3 feet: Sand'❑ Silt❑ C16y ❑ Pea.,❑ Sandy Loam ,❑ Clay Loam:❑ Hardpan ❑ Adobe-❑ Fill Material ___________ if yes;type -------------- t . (Plot plan, showing iize of lot, location of system in relation to wells, buildings, etc 'must be placed on reverse side.) NEW INSTALLATION:', (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ SEPTIC TANK [ ] 'Size----------------------------------------;= ---1 Liquid Depth ------------------------ Capacity ------- Type -------------------- Material----------------------".No.! Compartments -------------•--- •--• Distance to nearest: Well -------------------'----------..-------Founclation ---i'�:---------------------- Prop. Line ----------------- LEACHING --------- :--.LEACHING LINE [ ] No, of Lines ________________________ Length of each line-----------------------}*_ Total Length ______-___-_______._____... 'D' Box ------------ Type Filter Material, ..________Depth Filter Material ---------€_____________________________ � . ♦ I } Distance to nearest: Well ----------------------/Foundation ----------------- ------ Property. Line --------___-------- SEEPAGE PIT _-_-___SEEPAGEPI7 [ ] t Depth ____________ _ �� Diameter _____________ Number -------------------__-------[Rock Filled Yes ❑ No ' Water Table Depth -------------- - --------------...Rock Size ---------------------------- - --------------,----------- � r„ "Iv- t Distance to nearest: Well ----------:= :------------------_--Foundation .---- ------ Prop. Line -----_-------------- REPAIR/ADDITION(Prev. Sanitation Permit# --______--- --------------------- ----- -------------------- r 'r Septic Tank (Specify Requirements) ----- _-ez'-_----`"� -- ---------- ` r-49 --- `------ --------- ------- Disposal Field (Specify Requirements) �` ! 3 ---------------- I = ---------------------- -- _ ] --------------------------------- ----------------------------- Z ------------------- _._-_,-.---__ ------•----------------------- ; iw � (Drow..existing and required addition on reverse side) ' 1 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 We an Joaquin Local Health District. Home owner or licen- sed agents signature certifies the following: , "I certify that in the �ierformance of;,the-work--for-which this permit is issued, I sha14 aot employ any person in such manner I as to become subjectfioor an's Compensation laws of California." f_ , Signed -- - -�� _�'��-`'�------------------------------------------ Owner 6 t, � � l By ---------------------------------------- ---------------------------------------- --------- Title --- - -------------------------------- (If -----------------------------(If other than owner) I t FOB DEPARTMENT USE ONLY ) R - ------------ DATE ----�s - ----------- APPLlCATION ACCEPTED BY --------- _ __ __ _ _ BUiLDING_P.ERMI,T ISSU.ED._- -----------------------------------I - ------------------DATE ADDITIONAL COMMENTS -------------------- ------------------------•---------•------- ------------------------------------------------ -------- ----------------- 11 _______________________________________________________________________________________________________________�________.A'____________-________.__�._______- ___ _____-_______________.________-_ r + p Y"' -------- '-=�£== -Date _ f Z,J -------------- ---------- i -------- Final Ins ection b - +` -= =-_` ,�- _=— T = =-------- SAN sb SAN JOAQUIN LOCAL HEALTH DISTRICT n [. 3 E. H. 9 1-'68 Rev. 5M