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it FOR OFFICE USE"' APPLICATION FOR SANITATION PERMIT Permit No. _� �qq 1.._-- � ------------------ --------------- - --- (Complete in Triplicate) i ------ I--------------------------------------------- Date Issued ------------ - -------- This Permit Expires 1 Year From 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: �., te JOB ADDRESS/LOCATION .___ © -----h-- . -114-- i l�O_ ------------FSCALOJ�.CENSUS TRACT --------6-------- Owner's Name -- L /1� - = ----------------- Phone------------------------------•----- Address _____________ __ . - = :: fI � City -JF- CA-t-0-0 -------------------------------------•------ Contractor's Name ------------------------- License #2_q� �`� Phone2"_3 . Installation will serve: Residence ❑Apartment House❑ Commercial ❑TrailerICourt ;❑ ra Motel ❑ Other -------------------------------------- -- - p, _ i Number of living units:.._{__ -_ Number of bedrooms ..�---___Garbage Grinder . - Lot Size .- lE � "i- 21 Water Supply: Public System and-pame -- '- ----------------- -------------------------------- '---------------------- Private Character of soil to a depth of3-feet:,Sad' -tSilt ElClay ElPeat❑ Saridy Loam ❑ Clay Loam C] Hardpan ❑l --,Adobe'F7 Fill Material _ Q If yes,type ---------------------------- (Piot 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 seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT { ] SEPTIC�K�[ ] t Size---------------------------------------- - ---- Liquid Depth -------------------------- Capacity -- Type Material---------------------- .No. Compartments -----------------=-•-- 1 Foundation ---------- ----------- Pro Line -------------:-------- r Distance to nearest: Well ------------------------------------ p cc �yD "- - Total L'eK T �" LEACHING LINE - [ ]`! No. of•Linfs�.�- -;J� /1 _ Lerf eadKtfik� �?_C �-----.- - De aper cite l� �_� __ -- - 14a ----': T --TYP ., ( �`��ppCC **� - Fo ndi n e--- ; a A-4---- RP Ems' a ----------------------- ]�[7✓� ` "�is t ce to r t y4 o SEEPAGE PIT ] 5 IC qy `,. -----19P�t V Mb-------- -SRock Water Table Depth - ------- Y •- mss`: Rock Size j�,� Distancegto nearest: Well --------------4---- ''----------------Foundation ---------------•-- roP. Line - Date -------------------- ---------•---) REPAIRJADDITiON(Prev, San•itation_Permit�•,,;_:_�-----;--�-- -__-.-�._.-��.:��._�. entsl ---- --- - -------------------------------------------- ----------------------- ---------------------------- W ------- --:-------- .. Septic Tank (Speufy Requarem _ Disposal Field (Specify Requirements) _- t51--`--- - _ _s_ -_t>>i�- Cl _L�_Nt--`------ �� - /tea- �tL-----r-N-K----- —----- ` ------------------------------- --------------------- lhrnf ---------FIRS?M---------IF_11��-_:------ �. (Draw existing and required addition.on reverse side) I hereby certify that I have prepi red`fhe applicationand that alae work wiR"6e 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 performance of the work for which this permit is issued, I shall not employ any person in such manner as to be a subject "an'sm ensation laws of California." Signed . -4 -- --------------------------------------------- Owner ------ Title --- ---------------- ------- --------------------------------------- (If other than owner) i ! FOR -DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ----- ^' to--- ----------- DATE ---- k---- -- -S- `---------- -- --- --------- -------------------- DATE BUILDING PERMIT ISSUED ------------- ---- ----- - --------------- ------ - - -------___...w_� ._. . ADDITIONAL COMMENTS _ ___. -- ------ - ----- -- _ �._ ��_" _ -_ T 1 m - -_ _-- -- --- -- - - - -- - ------ -� { J-- f ---'-- '----- ---- ----- ---- ---- ----- - -__ .r --- - Final Ins e b s ' -- Date p ct�.PR...L-, ---- �- -- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M.