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FOR OFFICE; USE: APPLICATION FOR SANITATION PERMIT ------ ------- --------- Permit No. (Complete in Triplicate) ---------=----------------------------------------------- __________________ ------------------------------------- This Permit Expires 1 Year From Date Issued Date Issued s57A1 -7. 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 _51 - gq---- ------llr ---Zj---I�-------- �Te�- ------------------------CENSUS TRpACT --------�---.---. .---- Owner's Name -_.1A'��-.---------/F� /1��t� =-------------------------------------- ----------- --- ---PhoneGL��_�_��?_ Address sr DR`n- - ------------- Cit Contractor's Name ....4— J"1 ------- _I--II-4-------1�-4149.C$-------License # !F57;?367P---- Phone Installation will serve: Residence P�<partment House❑ Commercial ❑Trailer Court F Motel [-I Other -----------=-------------------- Number of living units:---.------- Number of bedrooms 12--------Garbage Grinder _ _.__,Lot Size ---C_ -- ___-_______ Water Supply: Public System and name -------------------------------------'J------------------------------------------- -- ------Private Character of soil to a depth of 3 feet: Sand' -'Silt ❑ ,.CI�y�;•❑ Peat ❑ Sandy Loam ❑ Gay Loam D - Hardpan ❑ Adobe,❑ Fill Material WO--- 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.) i NEW INSTALLATION: (No septic tank or seepage-pit permitted if public sewer is available within 200 feet,) (� PACKAGE TREATMENT � [ J SEPTIC TANK;[c.}---' Size__ ----------- - Liquid Depth ------/7-/d � Capacity/&XP29_____ Type -------------------- Material__��''�'� _ No. Compartments __ -A,- � ----------- Distance to nearest: Well ________9P---------------------Foundation _____� ----------- Prop. Line ___S—_____--_--_- N LEACHING LINE [ No. of Lines ------------- Length of each line------- ____---------- Total Length ___�_��.__-__----___-. 'D' Box ----1 ------ Type Filter Material -&-<----Depth Filter Material /�// ---- - Distance to nearest: Well ----5-6_------------- Foundation ----f_Q------ _---- Property Line _____��—___-_____ SEEPAGE PIT Depth ___________________ Diameter ---------------- Number ----------_--------------- Rock Filled Yes ❑ No ;0 Water Table Depth -------k=------------r---- ------------------..Rock Size ----------- ---- --------------- Distance to nearest: Well ____________________ ________________-_Foundation ------- ------- --- Prop. Line ___-_____-_-----___- REPAIR/ADDITION(Prev. Sanitation Permit# -------- ----------------- - -------------- Date ------------------ -------------) SepticTank (Specify Requirements) -------------------------------------------------------------------------------------------------------------- ----------------------------- Disposal Field (Specify Requirements) - ---------- _,_-_--•_ --�r�- ----------------------------- --- -------------------------------------------------- -- -- --- ------------------------------- (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 as to becloje subject to W km s Compen ation laws of California." Signed .!!`' ��l ---------------------- Owner BY .----- - --- ----- Title{If oth r tha FORD /RTMENT 115E ONLY BUILDING PERMIT ISSUED ----------- -`�---�- -------------------------------------------------------------- DATE: ----,�-w--`�---'�----------------- APPLICATION ACCEPTED BY ---------- - 4 --DATE ----- - --- ---- �-------------- ADDITIONALCOMMENTS -------------- ---------------------------- - --- --------------------------------------------------------------------------------------------------------- -------- - ------------------------------------ ------------------------------------------------- --------------------- ----- ----- - -- --- --- ------- - - / --- - -- ------------ ----------------------------------- ----------- ` Final Inspection by: ---- - - ---- ----- ---- ---- -----------------------------Date -- ._f -------C7 �--------- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'66 Rev. 5M