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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT c o ......G:1�'d_. Permit No.�.14.-9.IV, (Complete In Triplicate) - _... --------- --------_._...-_..... This permit Expires 1 Year From Date Issued - - Dale Issued x , I. 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 compliancewith County,Orrdinonce Noy. 5A49 and existing Rules and Regulations: JOB ADDRESS/LOCATION .... .-_ t ''t') ,�A1 . --..CENSUS TRACT _-----------_----y--/---- Owner's Name .--- .r r.�kIt ------- -------------....... .A--•--------------- - Phone .. Address ..-- , .--------- City _ --- ------------ --------- --- -------------- Contractor's Name L------- .......License# fU-_l?_,:5__1/ Phone_ Installation will serve: Residence Apartment House❑ Commercial]-]Trailer Court 0 Motel ❑Other------------------------------- --------- Number of living units:._......_ Number of bedrooms ..5------Garbage Grinder ----_.... .. Lot Size ............. _----- Water Supply: Public System and name --- - -----------------------•-------------------- •-•-------__.--Private p14 Peat Sand Loam Clay-Loam Character of�s"oil to a depth of 3 feet: Sand'Q Silt❑ Clay ❑ ❑ Y ❑ Y ❑ Hardpan ❑ Adobe IV Fill Material ...._ ------ If yes,type_____________________ r� o� buildings, etc. must be placed on reverse side.) [Plot plan,,showing size of lot, location of system in relation to wells, NEW INSTALLATION:f-••(No-septic tank-or-seepage•pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK T ] ze........ __x__I.... ................ Liquid Depth ____.. - ---------------- Capacity Type Materials_._ No. Compartments ------------------ ln1 r r Distance to nearest: Well _. .........e.. .Foundation .._../0_......_ Prop. Line ...................... \ LEACHING LINE [ ] No. of Lines :,._•.:�............. �ength of each [:ne ft.-,, Total Length ,-�.�D-- -----• ""`21 Z ✓� n n D' BtSx ... ..--.... Type Filter Material R,Q, _.._Depthy,Filter Material ..-_.��___--- ------ - -�_ - Property Line \\ r M r Distance�t*o nearest: Well ___/+�._-_.:-__=Foundation ...... . . ....... -----------_----------- SEEPAGE l�. � iY � y�C I PIT [ ] Depth ...�-._......_ Diameter,..�_3..__..__ Number __._�:;` _,./._�._.. Rock Filled Yes V No III Water Table Depth _______________�...__..._....j_.._.._..------__Rock Silie Its-- i Distance to nearest: ell ...._._I-/oQ......................Foundahon _ -._.......-.1._.. Prop. Line ...................... - I& i REPAIR/ADDITION(Prev. Sanitation Permit# -'------------------- -- ------------- Date ..-------------------------------- Septic Tank (Specify Requirements) .__.----._-..___ `J'= ~ V- Disposal Field (Specify Requirements) ._._. •---•--_S�;c .....---~...........................I. ......................... i -•-•------- ............... �,------ ---------------- -------- ------------------- -------------___-- CC' \ ------ ----<Ni------------- --- ------------- ; (Draw existing and required addition on reverse side) .J,J 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: \ 1 j "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 Compensation laws of California. Signed .------ -----•--------_--- Owner" By e ` (I other th wned Z7�C , FOR DEPARTMENT USE ONLY 7 'A JRt qi o APPLICATION ACCEPTED BY---------- '_ -'------------ at—(................/.__....._. .........._.._._.._ . DATE _11 .1., -16_9---.. _--_.--__-_ BUILDINGPERMIT ISSUED -------------- --------------------- ---- ----------------- DATE .-. -._.---------------------- ........... + ADDITIONAL COMMENTS _ --_-------------• ._ --- � --------------- ----_------------- ...........................................� -- _ -- ------..._.._------------------ -------------------------------- -------------------------- ----------- - -------- ----- --- ------------------ - ---•--------_..-•---- --- t Final Inspection b f�os_-- _-- ________________•--- - ---.Date __... -_--�- _-- -------------- '' t.SAN,-<JOAQUIN LOCALSHEALTH DISTRICT 011 E. H. 9 1-'68 Rev. 5M t