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. ... y . FOR OFFICE USE: � AhiPLfCATION FOR SANITATION PERMIT ----------------- ------ ---------y - --'.--------- Permit No. -- ----- 9 (Complete in Triplicate) i ------------ ---- This Permit Expires i 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 --------------------------------------CENSUS TRACT --------------w- _ _.=--Owner's Name.,' =p TZ-7 r------- ' ./ � _/yl s4_/L� Phone-C= Addressd X&-, �C Nf <� ----------------------• City -------------- ------------------------- !� - ------------------------------V = Contractor's Name � n ---------- - ---------------------------------------License # _ Phone��3_�`yp Installation will serve: Residence [ Apartment House❑ Commercial:❑Trailer Court ❑ - , Motel ❑Other ---------------------------[---=-- Number of living units f----- Number of bedrooms --: -__Garbage Grinder ----_ `__ Lot Size _fl.o4qcw�t -_._______- Water S pply: Public System and name ------------------ --------------------------- --x-------- -------------------- I -----Private Character of soil to a depth of 3 feet: SandT!J""Silt❑ Clay ❑ tPeafi Q Sandy.Loam ❑ Clay Loam :❑ Hardpan ❑ Adobe'❑. Fill Material __`_______If yes,type ---------------------------- (Plot ____________t____________(Plot plan, showing size of lot, location of system in relation to wells, (buildings, etc. must�be"placed on reverse side.) NEW INSTALLATION: (No septic tank or seepapit permitted ifbl�iceyve� is avlai�l��le"within 200 feet,) !� PACKAGE TREATMENT , [ ] SEPTIC TANK:ill Size_9____ __X_ __ -__ _`2' -"--- - Liquid Depth _-7`�=----_"-__.____- (r : i $ { l �Q___-__- Type�O��`-- - aterial N�. `Compartments ------------------- Capacity Distance to nearest: Well _________:___:Foundation _/V--------------- Prop. Line......_.__ LEACHING LINE f#[ No: of. Lines _ ______ __ _ __ Length of each line.__ L.___-- "-------+Total Length -..____________ � � 'D' Box _ Type Filter Materia��C4-_____Depth Filer Material."/--------- _-------...... i Distance to nearest: Well -- ------------- _ Foundation AP____________ _____ Property Li __________........ - - SEEPAGE PIT f[ ] s Depth ____________________ Diameter __________-___ Number�_� :__._ Rock Filled Yes ❑ No �] t. 1- 'Water Table Depth ----------;--- -------------------- tt-------Rock Size ---------------------------------- I --- -------- ------------------ I Distance to nearest: Well _ _'__________________._ _`�_______Foundation -------------------- Prop. Line ---------------------- .I ; REPAIR/ADDITION(Prev. Sanitation Permit# -----------------------------------=--=------Date ----------------------------------11 Septic Tank (Specify Requirements) ------------------ ------------------------------------ --------------------------------------------------- --------- -------------------- Disposal Field (Specify Requirements) ----------------------------"-------------`--- -------------------------------------------------------------------------------------- ------------------------------- l --- b. (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: ' "f certify that in the performance of the work for which this permit is issued, I shalt not employ any person in such manner as to become subject to Workman's Compensation laws of California." Signed -------------r--=:------------------------ Owner - s � -------------- - By - @___1 �' ------ Title _�LG ld'� .-C ---------------- (If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY 4- ------------------------ ---------------- -----. DATE ---1, _l_` _ ----.-------- - BUILDING PERMIT ISSUED ------"_[-----------------------------;--------•------------------------- ---------------------- - - -----------DATE._.---------------------------------------- ADDITIONALCOMMENTS ----_---0----------------------------i--------------------------------------------------------------------------------------------------------- r !.1 -------•----------------------------------------------- ------------------------------------------------------------------------------------------------------------------------- t , ------ ---- - - ---- -- ----- ------ -- - ----- _ Final Inspection by: ------ ----- -------------Date .- '- -------------------------------------- ------------- z /=1 --- -- ------------------ t SAN JOAQUIN LOCAL HEALTH DISTRICT s I E. H. 9 1-'68 Rev. 5M