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FOR OFFICE,USE: _ APPLICATION FOR SANITATION PERMIT Permit No: --------�------------- ----------- --- ------------ ---- ------------ (Complete in Triplicate) ' ---------------- p Date Issued g. 7^ This Permit Expires 1 Year From Date issued - -- ------- --- � 222+ -�OZ • . Application is herey made to the San Joaquin°,Local Health District for a permit to construct and install the work herein described. This applVIO n is made in compliance with County Ordinance No. 549 and exis�tiing Rules and Regulations: C V --------- ----JOBADDRESS/LOC .--------0-�---- V wD -pf` e" t,- _�--- � �R ENSUS TRACT _--- Owner's Name L�` C]- ._L --`----------------- -=---- ----.-Phone - >. a F M ! = C Address - Z---------pv--------------• . city ' = - A Ii30�p�. --------•----------- License # ---- -,------ ----- Phone -------- -------- ------------ Contractor'shame _.�_�/V.E- - -------------------------------------------- ., Installation will serve: Residence ❑ Apartment House❑ Commercial :❑Trailer Motel ❑Other ------------------------------ ------------ Number ----- --Number of living units:-_.__I- -_--- Number of bedrooms -�------Garbage Grinder ,-- Lot Size -- -----.- ` ------------------ -----•-------------- -------------------- -------- --Private �. Water Supply: Public System and name ------------------------- -- ------- �. Peat Sand Loam ❑ Clay Loam a Character of soil to a depth of 3 feet: Sand'El Silt❑ Clay ❑ ❑ y i Hardpan F-1 Adobe F-1 . Fill Material -f-Y- ---- 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 Xsee age pit permitted if public sewer is available within 200 feet) L; uid De th / .. . PACKAGE TREATMENT ] ] SEPTIC TASize__ �"�_I-X_ --------- q p ` p -----�t-. Capacity 4Type ?f?_SD... Material---�PPVCn,__ No. Com artments S Foundation ---------- 1Q Prop. Line Distance to nearest: Well ---- _--.--_, ------ r �_- -------- LEACHING LINE j No. of Lines ---------- .- °--- Length of each line-___--: -Q------- ------ Total Length .--- -_ E 'D' Box Type Filter Material•`�-O_C-K--___Depth Filter Material __-- -:- i - - ------------ ^ .- .- :: ---'}'- Foundation=---`_--=--1Q-t-Property--Line.=-------:'=----------- - - Distance to nearest:-Well - ---------___ ,, I [ ] Depth Diameter -- Number Rock Filled Yes ❑ No ] SEEPAGE PIT --------------------- ------------------ Water Table Depth ------------------------------------------------Rock Size ------- -------- Distance to nearest: Well ------------------------------•---- ----Foundation -------------------- Prop. Line --------------------- 4 ----- Date ------------------"------------'`-1 REPAIR/ADDITION(Prev.(PreySanitation Permit# ------=------------------- --- --------- ------------------------------------------ - - Septic Tank [Specify Requirements) ___:-___--------------------------------------------------------- f Disposal Field (Specify Requirements) ------------- - - ---------------- - -------------------------'------_---- ------------------- - ------------------------------------- ------------ -- -------------------- --------------------------------- -------- ------------- - _ _ �;. ----------------------------- --------- - ----- ---- - - - - - - - ----------- --- (Draw existing and required addition on reverse side) I hereby certify that 1 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: f "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 beco subject to Wo an's Compensation laws of California." SignedOwner Title -------------- ------------------------------------ -------- ----------- i, --- -------------------------------------------- ---------- (If other than owner) FOR DE ttTMENT USE ONLY q APP�ICAT1`ON ACCEPTED BY -----:moi�,_P------------ ----------- ----------- --------- -------------------------• DATE -..--../--'-�1--Vit ' BUILDING PERMIT ISSUED --------- r - .... -----"---DATE ------------------------ - --------------- ADDITIONAL COMMENTS ---- ----------------- _ _ - - ---------Date---- - -�i _ ----------------- - - - ------------ ------ ------------------------ Final Insp SAN JOAQUIN LOCAL HEALTH DISTRICT ' E. H. 9 1-'68 Rev. 5M