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FOR OFFICE USE: " APPLICATION FOR SANITATION PERMIT (Complete in Triplicate) Permit No. ------ " ----------------------------------------------------- --- / ---------------------------------------------------------- This Permit Expires ! Year From Date Issued Date Issued __//4__1... 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 -----� -—-------------- --- CENSUS TRACT -- --------- R --------�� T 19_UVE__S-------------- - Owner's Name -- Phone Addressf`—-------------------------------- citT4 ------- Contractor's Name ---A4_VR_hi/_ -------81_C_Y,140�------------t---------License # ------------y---- ---- Phone ------------------------------ 4 Installation will serve: Residence Apartment mouse ❑ Commercial :[]Trailer Court ;❑ Motel ❑ Other ------22------- ----------------------------�/ r -4— Number of livingunits:_________ Number of bedrooms J Garbage Grinder_ ___ 1,57,p / _ ______________. g / _ Lot Size -- Water Supply: Public System and name ;-----------______ __-^___-_________/___. `^-----------------------Private �— Character of soil to a depfk of 3 feet: Sand Silt❑ Clay E] PeatSandy Lo6m ❑ Clay Loam EJ Hardpan E] Adobe ❑ Fill Ma -terial 9--__ If yes,ty4pe ____________________________ �.. (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 seepa a pit permitted if public sewer is available within 200 feet,) f, PACKAGE TREATMENT { ] SEPTIC TANK Size__j_'_ _ _X___" _____________ Liquid Depth -___ -_._--__,•_-_. Capacity _.LZO_-----__ Type C.&S aterial_6Dk.0-1k -No. Compartments i 4 Distance to nearest: Well ____ _/ ___-___,____Foundation..1 _ " -___ Prop. Line ___ .?-_- `____ LEACHING LINE [ No. of Lines _�-------------- Length of each line.__._.': ------_.____�Y Total Length ....... 'D' B/etcotearest: Type Filter Material ,� C-<Depth Filter Material -------t- Disto Well - --- --______-- Foundation . �"___ Property Line _ ------------------ .� SEEPAGE PIT [4' Depth ------- Diameter ________________ _Number --------------------- Rock Filled Yes ❑ Na C Water Table Depth ------- �•------=------------------------------Rock Size ---------------------------- Distance to nearest: Well�--�--------------------------------.Foundation -------------------- Prop. Line --------.- ........... REPAIR/ADDITION,(Prev. Sanitation Permit# -------------------------------------------- Date -------------------.--------------) Septic Tank (Specify Requirements} --------------------- -- ---------------------------- DisposalField (Specify Requirements) -------------------------------------------------------------------------------------------------------------------- --------------- ---_-------------------------------------------- -------------------------------------------------- _____._____-_____--._ ____ _______________-___ - ___________________________" (Draw existing and required'additionon reverse side) r 1 hereby certify that ! 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 become subject to Workman's Compensation laws of California." y Signed --- `�_` . ----------------- Owner BY/�UY�'[_- !' "'=� ---------------- Title ---------- ----------- ---------------- ---------------------------- --- - - ----------------------------------- (If other tha ner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY � i -0----------- ------`---------------`-----_-------=---------------. DATE -��--3t"-7-72L__ ._ BUILDING PERMIT .ISSUED ------------------------- ADDITIONAL COMMENTS ----- -------------------------------------------------------------------------------- -------------- ---------=-- ------- - ------- ------------------ ------ ----- -- --------------------- ------------------------------------------------- --------- --------------------- ---------- ----------------------- ---------------------- -------------- ----- Finallnspection ' Dates _ - - -------- ----- --------- SAN JOAQUIN LOCAL HEALTH DISTRICT �y .1 4 E. H. 9- 1-'68 Rev. 5M