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FOR OFFICE USE: lie _APPLICATION FOR SANITATION PERMIT = � = °'-------------------- �� / (Complete in Triplicate) Permit No. .____._�__d76 ------------------------------------------ - - - - f�� Date Issued .�a-3v_ ___--_____-________-`F ___ ------------- This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joagyi:n Local Health District for a permit to construct and install the work herein described. This application is made in compliance with County Orrrdiinnance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATIO /OV-6- - - -------------CENSUS TRACTOwner's Name - - - - Q-- - ------------- --------A--------Phone Address ----------------•5 1/_(6.1_ 4F ---•- ----- ---------- --. City -- - - --------------------------•---••-----•------ Contractor's Name ..----.-------- ___ ._ ----- - —---------------------- #l0�l/------- Phone 7.•d' :7- X�A.7. Installation will serve: Residence Apartment House,❑ Commercial []Trailer Court :E] Motel ❑Other - - -- ------ �� / Number of living units: --- ----- Number of bedrooms . 3..._Garbage Grinder _f�1lJ__ Lot Size ------ ......... - Water Supply: P;ublicSystem and name -------- - --------Private Character of soil!to a depth of 3 feet•. Sand'❑ Silt[] Clay- E] Peat❑ Sandy Loam ❑ Clay Loam ❑ Hardpan ❑ Adobe FiIVMaterial ________ If yes,type _-•_____-_________________ (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) �f NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) / PACKAGE TREATMENT [ ] SEPTIC TANK': I Size----------- -- _,____ Liquid Depth __ ............... Capacity Type _T Ajar _ Material ------ No. Compartments 2 4 Distance to nearest-, Well ___/ l.t_______________Foundation ------/0__'�`'_._ Prop. Line ____--____- w / �0 LEACHING LINE No. of Lines ____ _ --- __ Vbnjgth�'of etxch line-----Sr. - ___ ______ Total Length .............. 'D' Box __ _lam'-- Type Filter Material - Depth Filter Material ---.1 /-- -------------- Distance to nearest: Well ---&V-t=__.__. Foundation ---/VV---- . Property Line _____________________ SEEPAGE PIT Depth __ � _. ._. Diameter 33-'!--- Number ------_S�------------ --Rock Filled Yes V No C]Water Table Depth --- Water Size __lf ---r.1------------ Distance to nearest: Well ____/ '__f____________________Potrn�dafion a_�___--__. -Prop. Line ...................... REPAIR/ADDITION(Prev. Sanitation Permit# -------------- ------------------------ Date ___-_.-___-_•.-____..___.________) Septic Tank (Specify Requirements) ---- ---------------- -------------------------------,.-,_ -_- -- _----, ---------- Disposal Field (Specify Requirements) __-__-______ - - ------------------ -------------------- --- --------------- ------------------------------ ----------------- ------------------ -------—--------------t_4_4---------------------------------------------------------------------------. -.___-__._. ____ __________ __ ,___.__.._.W.�.... ----------------------------------------- .__.._._ _ _______. 4_.__._._ __--____ _.___.___-___.__-_. -. -_ .________--_----.___.__ ._____ (Draw existing bnd,required additioh ch reverse side) I hereby certify that I have prepared this appl cation and that`the work will be done in accoFdaece with San Joaquin County Ordinances, State Laws, and Rules qnd,Regulations of the San Joaquin Local Health District. Home owner or licen- sed agents signature certifies the foRAwing: "I certify that in the performance of the-Work for which this permkis iswed, 1 shall not employ any-person in such manner as to become subject to Workman's Compensation laws'of California." Signed --------- - ------ ------------------------- Owner By ----- ------- - ----- ------------------------ Title ------ ------------ - -------- - --------------------------------------------- (If other a owner) FOR DEPARTMENT USE ONLY i ----------------- DATE ----L 3 Q -------_--- APPLICATION ACCEPTED BY - - ------------- -- ---- -- ----------- DATE /- BUILDING PERMIT ISSUED ________________ ADDITIONAL COMMENTS -------------.----------- ------------------------------------------------------ ----- ------ ----- ----- -------------------------------------------------------------------------------------------------- ---- ----------=------- FinalInspection by: =-- ------- ------------------------------------------------------•------------------ -------------------Date _..__t SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M