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k FOR OFFICE USE: , APPLICATION FOR SANITATION PERMIT / -------------------------------------------- ------------ (Complete in Triplicate) Permit No. ---------=------- ------------------------------------- Date Issued -V-F ------------ This Permit Expires 1 Year From Date Issued --7D 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: i JOB ADDRESS/LOCATION _ � ------- r ---c-----f (_ Q ------C .�---------------------CENSUS TRACT ---- ��-_---• Owner's Name l!11 �}_n/ -- V LCL P �� 1+ 1/f Phone ,/ . -. Address b-Gly •/ )-91 - 124�m�--------. city I � �r✓ Contractor's Name -.�--�.�---�-- - -r��/-�'..J�---------- - -----------------License# � T0'7,�--- Phone Installation will serve: Residence 7Apartment House-[] Commercial :❑Trailer Court EJ Motel ❑Other Number of living units.-I-1--- Number of bedrooms -a2......Garbage Grinder ------------- Lot Size ..- _E—_------_ Water Supply: Public System and name ---------------------------------•--------------------------------•------- ----------------------•-----------Private Character of soil to a depth of 3 feet: Sand Silt❑ Clay❑ Peat❑ L ❑Sandy Loam ,[] Clay Loam r - Lo --- If yes, type _______-------------------- Hardpan ❑ Adobe ❑ Fill Material _�f (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,) \ PACKAGE \ ' G TREATMENT ' [ 7 SEPTIC TANK�[ ] ize---------------------------------------- - ----- Liquid Depth -------------------------- Capacity ------------------- -------------------------Capacity ------------------ Type -------- ---------- Material--------------------- No. Compartments - ---------•-- Q Distance to nearest: Well -------- ---------------------------Foundation --- ------------------ Prop. Line --------------.._...._ �] LEACHING LINE [ ] No. of Lines ------------------------- Le gth of each line--------------------- ------ Total Length --------------------------- 'D' Box ---------- Type Filter M eriaf --------------------Depth Filter Material __---.-_-__--.__--_,-------- Distance to nearest: Well ------- ---------------- Foundation -.-------__ _-------._ Property Line -___-_-_.----- SEEPAGE PIT [ ] Depth ---- --------------- Diamete --__-----__-_--_ Number - ---- --._-_.____- Rock Filled Yes ❑ No i❑ Water Tal Depth ------------- --____-_Rock Size ---------------------- --- Distance to nearest: Well --- - ----------------------------_-__Foundatl -------------------- Prop. Line ---------------------- REPAIR/ADDITION(Prev. Sanitation Permit S# -.------------------------------------------ Date -----------------------------_--_-) Septic Tank (Specify Requirements) ------ - --d'r__------_ _ -_(�-_--_ !!✓_ b , Disposal Field (Specify Requirements) -- - ' �r s_7?? lL------------------------------------------------------- R: ------------------------------------------------------------------------ ------------------------ -.- -- - - - I �} (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: "I certify that in the performance of the work for which this permit is issued, I shall not employ any person'in such manner j as to become subject to Work on's Compensation laws of California." Signed C -- - --- ---------------- ------ Owner BY �- -- -------------------- Title -------------- (!f other than owner] FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ---- -"-------- -------------. DATE------ BUILDING PERMIT-ISSUED ---------------------------------- -- -- - - ---- --------------------------- ---.:,.- .------------------------DATE --------------------------------------------- ADDITIONAL COMMENTS = i r , --------------------------------- ---------- ------- - -- - ------------------------------------------------------------ --- ---. -------------- -- ------------------- ------------ - ----- ----- ----------- p Y ---- -- ----------------------- -- --------------------Date -- Final fns ection rr 1 SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M