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FOR OFFICE USE: kPLICATION FOR SANITATION PERMIT 1 q _.. - _ _ -= A7 � _ Permit No.- ---- ------- (Complete in Triplicate) This Permit Expires 1 Year From Date Issued Date Issued 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 __-- L.�7 _-�..----/71 R-PO_RT__ .-Ay_.-_.---._ ..__ CENSUS TRACT ----------- ............. Owner's Name .... ---------iF-------- ---------------- ---------•- ---- -- - - .Phone - - - ----- -- ------- -- Address .. /_g_ftrO.-PST------WR/.....---. city /1'R�A - -- -------------------------------------------- Contractor's ------------------------------------------- Contractor's Name - --.--.-------- ---------.-------.License # ------- --_ - - - Phone ------ ----------- Installation will serve: Residence Wi partment House❑ Commercial❑Trailer Court 0 Motel ❑Other -------MOVEp_-_t/V-._-------_. / AM Number of living units:_ j_:-. Number of bedrooms .=3------Garbage Grinder __ x_&_- _ Lot Size _-1 -.--_X_.... _ ------ Water Supply: Public System and name ..............__ Private - — --- ---- Character of soil to a depth of 3 feef: __Sand'Q Sift❑ -Clay ❑ -:Peat❑] Sandy Loarh p'1__Clay Loam ❑ Hardpan ❑ Adobe ❑ Fill Material If yes,type (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 206 feet,) d PACKAGE TREATMENT ( ] SEPTIC TANK Size.._ .y��X,1[—__- ___--.------ -- Liquid Depth ....f/�-__.. \l.... V Capacity .�` U_._:.Type ..�.� Material...0W.Q- No. Compartments .-.....�.......... (� Distance to nearest: Well .___ ?��_ "� ...... __.Foundation f - Prop: Line _.5a_..._..!_..... ` LEACHING LINE No.'of Lines __.-._� '___ Length of each line.. _-_9Q _-- Total Length -----/90-- J�tl D' Box yEa Type Filter Ma Rd:CA____Depth Filter Material _- �__ "t >� 9 , Distance to nearest: Well ---------- _.."r foundation -------------------- Property Line :S_._.-C____.--.---_ SEEPAGE PIT. [ ] Depth ----- .. ---------- Diameter ._.-_--.-- .... Number - __.-_._.-.__...-----__ Rock Filled Yes ❑ No Water Table Depth ._...--_ . - --- --Rock Size --- -- � r _ Distance to nearest: Well ----------------------------------------Foundation ----.------__..---- Prop. Line ------..--..-_------ REPAIR/ADDITION(Prey. Sanitation Permit# -----..............-..--______ ---____ - Date _______--------------------------) Septic Tank (Specify:Requirements) -------- .................... -------------------- -------------------------- -_-------- --- ------ - -- - ._ •- ----------------- Disposal Field (Specify Requirements) --------------------_------------------.- (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 beEog^le subleqt to W r n's C{jhpe6sation laws f California." Signed ✓j/�(1'� .. (�J .-------------- Owner BY .- _.. - ------------- - T�IZ.Q_: Jitl"e (If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY .4E(=-_�....N-AL[__...._..3 - --- . ------------ ----------------------- 1 ' BUILDING PERMIT ISSUED ----•------ -_-------- --- -- --- . . -----------------------------------DATE ------------- --- -----------••---------------- ADDITIONALCOMMENTS .............. ............................................-----------..-..----------------------------------- -------------•--------- --•--•---------------- ..----• ---------- ---- -------- -- ---- -- --------- -----------------•---••-•----------•--...----•-----••••••--•---•--•-••••.....----------------------------•-•-----------•-----. ............... .................................. ----- .. . ....................••...-------••----•-•----------•-•-•••••-----•----•-•------••-----•-------------------.......--------•------.... .......... - ------- -- ----- - - -------------------------------------------------------------------I----------- _f� Final Inspection by: - --- . . -••.............•---•--••----------••..--•--------•....----- --------------.Date SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M