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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT (Complete in Triplicate) Permit No: _ � 3--_ ---------------------------------------------------------- This Permit Expires 1 Year From Date Issued Date Issued r! ': ' 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 ------- --- c- ---- ------------------ ---------CENSUS TRACT --------------•---•---._.. ' Owner's Name ------ ./L�[- _4 � `pL� ,� �'s ' Phone._._7__72 J `14 i Address -------- -- -----f- Cit ! ---------------- Contractor's Name --- .License ---- Phone ------------------------------ Installation will serve. Resi*Irpartment House❑ Comrriercial :❑Trailer Court F i Motel ❑ Other ------------ --------------------------- ' w Number of living units.-__4._-.._ Number of bedrooms -----/-----Garbage Grinder ---_- ------ Lot Size ------------------------------------__-_--- I Water Supply: Public System and name ------------------------------------ __________________________Private 2r_,� { I Character of soil to a depth of 3 feet: Sand?❑ Silt❑ Clay ❑ Peat ❑ Sandy Loam ❑ Clay Loam.E] s Hardpan ❑ Adobe Fill Material ------------ If yes, type -_-_____________________-__ I (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 seepage pit permitted if public sewer is available within 200 feet,) ` g / �/ i PACKAGE TREATMENT [ ] SEPTIC TANK'( ] Size-� ------ ------------------ Liquid Depth -----------------------•--. tnl Capacity _jc3t4_0_ Type B_4410,40)_ Material-�� (?- --- No. Compartments �.....:.......... - > - C d Distance to nearest: Well --------&V------------------Foundation _-._-- -f7----------. Prop. Line------I:-------- LEACHING LINE ( No. of Lines /_ g e_ g I -------- - ------------- Len th of each line---____-- -©--�--.--_--- Total Length ......... ..--.-•-- R l 'D' Box . _.. Type Filter Material __ / `_-__.___-__-Depth Filter Material '`____________________ __ i Distance to nearest: Well -------- Foundation ..... ---------- Property Eine -..f----___---#-•-.:.... SEEPAGE PLT [ ] Depth _-._ --------------- Number ---------------------------- Rock Filled Yes No - - ------- Diameter --- ----- � ❑ !❑ 1 Water Table Depth --------- ------------------------------------.-Rock Size --------------------`--------- F Distance to nearest: Well ----------------------------------------Foundation -------------------- Prop. Line ----------.._...--__-- REPAIR/ADDITION(Prev. Sanitation Permit T# -------.--------------------------------:--- Date ----------------------------------) Septic Tank (Specify Requirements)- ------------------------------------------------------------------------------ Disposal Field (Specify Requirements) ----------------------------_----------------------------- ji -------- ------------------- -- r ------------------- ----------------- -------- . --------------------------------- ----- ---- -- - t M# {Draw existing and required addition on reverse side) r` I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin r County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health Distr)ct. 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 become subject-to Workman's Compensdtion laws of California." ' Signed -------------------------- +y�}� Owner a-�v.-est_ ------------------ Owner - , - -- --�i= ------------=-- Title ---------------------------------------- Of other,than owner) FOR DEPARTMENT USE ONLY -M . . APPLICATION ACCEPTED BY _ `-CC roa -------- -----------------------------1-------= DATE - -,,?L7 BUILDING PERMIT ISSUED _.___..__.:�__'-` ._ - -------------- ---------------------------------- --- ---------'------------------ DATE ------------------------------------------- ADDITIONAL ------------•---------------- - ---------ADDITIONAL COMMENTS --------- ----- ---------- -------------------------------------- I ------------------------------------------ ------------------------------------------------ ---------- ------ ------------------------- ----- ------------- ------- ---------------------------------- - Final Inspection by: C-�£ -T - --- ------------ --------------------------- -------------------------Date ---- P. - --Z - SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M