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r + Y ■ w FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT x --------------------=-----------------------n---------- Z (Complete in Triplicate) Permit No. This Permit Expires 1 Year From Date Issued Date Issued -_�- -�--�_-�.7i __________________________________ ----------- r Application is hereby made to the San Joaquin Local Health District,for a per to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549 and existing Rules a,nd Regulations: CENSUS TRACT -------------- 4 JOB ADDRESS/LOCATION .----.L_fZ --------'/------ � � T_----- -- ----------- ------ v � Owrier's Name � �T ---------1-- to -/q--•• ------------�------------- [ ---------------- -------Phone Address -----17�7Q--------�--------1114—E V-'- ---- City l 1�.:1' Contractor's Name -----OlAWE R--.---------------- ------------------------------------License # --------:--- _--------- Phone - --------------------------- } Instalfation will serve: Residence Apartment House^❑ Commercial :❑Trailer Court Motel ❑Other -------------------------------------------- - - - -------------- Number of living units:-----1---- Number of bedrooms --"Garbage Grinder .__ Lot Size _R` FT�______-____ Water Supply: Public System and name ------•--f-------------------------------------------------------- ------------------------------------------ Private Character of soil to a depth of 3 feet: Sand'❑ Silt j] Clay ❑ Peat ❑ �Sandy Loam �ay Loam ❑ Hardpan❑ Adobe E] Fill Material _!1Ay j p T 4 (Plot plan, showing size of lot, location of system in relationdto wells-buildings, etc. must be placed on reverse side.) NEW INSTALLATION: (No septiCtank°: r se page�pit permitted if public sewer�'is avails �e within 200 feet,) PACKAGE TREATMENT [ I SEPTIC TANK j Size_-----_-___------__________________ ---_ Liquid Depth ----------------- -------- Capacity 3 _----' Type, T ---------------- Material---------------------- o. Compartments ----------------------- v P Y ---_----_ -- --- Distance to nearest: Well'________________ _ ____-_Foundation ----- ------------- Prop. Line ---------------_------ Q LEACHING LINE [ ] No. of Lines -- ------ ----___ Leng�wof each line___________________ ____ ' Total Length _ -------------------------- I r TTp 'Filter Md_teriaK-,- ----------------Depth Filter M terial -----I--------------------------- 1 to nce to nearest: ell ---- ------------------ Foundation ------------- --- -h-- Property Line ------------------------ SEEPAGE PIT [ ) Depth) _____ ______________ Diameters Rock Filled No ❑ f Number"`._ ` =- Yes ❑). Water, Table Depth -------------------------- -------- ------Rock Size ----�- ---------------------- I Distance to nearest: fl - _�--r_______________..__________Foundation . ----- ------- Prop. Line __________._.-.---".-- � 1 1 - REPAIR/ADDITION(Prev. Sanitation Permit '--`-..--- -------------------------- Date ---------------- --i_________-- - ----- - i f Septic Tank (Specify Requirements) -------- -- ---------------------------------------------------- k, -------------------------- y „ ------ ------ ---------- ---- Disposal Field {Specify, Requirements) ---hs-f-_�Oax-------------------3__�---------Q>�--------2�---�----W?��----------------- i ( 3 { i ------- ---1� R----('_K� '� � P c r_ Ir E -------------- S_9OWN-----------6Q---- P....-- 1 -b- REcom. ---- --/S`0 V------------------- --------------------- -. --------------------- (Dra xisting 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- i sed agents signature certifies the following: 1 "I certify t t in the performance he wor for which this permit is issued, I shall not employ any person in such manner as to beco ubject to Workm s Co pe ation laws of California." Signed ---- -- - -------- --------- ----------- -------- Owner r s f Title ------------------------ i BY ---- c`--- --------------------------------- ------------------------- R (If other than owner) FOR-DEPARTMENT--USE-ONLY- -------- APPLICATION ACCEPTED BY ---------- --- ---------`=----------------------------------- DATE -----1---"„--�C1---�-�_ BUILDING-PERMIT.-ISSUED ------------------------- ADDITIONAL --------- -- `ADDITIONAL COMMENT - --- --- ------------------------------------ -------------------- ------------------------------------------------ ----------•------------- ------------------------------------ ---------- --------------------- --- -------- ----- -- ------------------------------------------------------------------------------------------------ - r = ----------------- ------ --- --=------ ------- - - ff - Final Ins b -- ------ --- --- -- ---- - --- V------------------------------Date SAN JOAQUIN LOCAL HEALTH DISTRICT '� E. H. 9 1-'68 Rev. 5M