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� FGR i r OFFICE USE: APPLICATION FOR SANITATION PERMIT Y 7�6/ /l7 t [Complete In Triplicate) Permit No. ..................... ..........,............................•--................ .... 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 Ne. 549 and existing Rales and Regulations: JOB ADDRESS/LOCATION 93.13 ...... ....... ..... •-----......CENSUS TRACT ..06.•............. Owner's Name .CTL �f"� ,/Jf�,_. �.J --------------------------------------..........................._..._.Phone .�f..7?:..75`��...._ Address -------• Ti saAv,c . _........__ .... City Contractor's Name __ -x-A lie_ _ / ..........................License # _?Y9/_11._ phone —1.1ZZ .... ..... Installation will.serve: Residence_o_Apartment House C] Commercial❑Trailer Court 0 Motel p Other------- -----_------------ --------------- Number of living units:-._-.f.--_ Number of bedrooms ..2-.__Gorbage Grinder -.✓._. Lot Size ............................................ N Water Supply: Public System and name ..-•..............................._.-----•-••-----............-•------------.................---.............Private,; Character of soil to a depth-of 3 feet: Sand b' Silt❑ Clay ❑ Peat❑ Sandy Loom V1 Clay Loam ❑ Hardpan=} Adobe 0 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.) J NEW INSTALLATION: (No septic tank or seepage pit pgrmitted If public sewer is available within 200 feet,} PACKAGE TREATMENT.. j ] SEPTIC TANK I jJXl,s�in q Si � .................... Liquid Depth ..................... Capacity ---•----- Typf�// e .V �rrrer - -.•--- Material-�p�,r�__.-_-_-- No. Compartments ...Z.............� Distance to nearest: Well ....................................Foundation ...................... Prop. Lime ......................sy LEACHING LINE { ] No. of Lines ...__,�................ Length of each line..._.?V._..__ ........ Total Length ..7.0................ 'D' Box .. ......... Type Filter Material 4t .....---Depth Filter Material .Zq.f .............................. Distance to nearest: Well ---.Sb.f'..___..._ Foundation ........_... Property Line ...5-1 .......� 5 PIT [ } R ------ Nuff4ee--:•------- ---------- Roek-Fi r Distance -------•- ... Prod-•alt .. _:................� REPAIR/ADDITION(Prev. Sanitation Permit# _._ ........................................ Date ..... ............................ SepticTank (Specify Requirements) ---------------------=------------•-•--..... .................. ........................--....-....... /...__....----......... Disposal Field (Specify Requirements) - .fr/. -•--- ...._� G ...0 -�=-•---. _.t' Y.�4?�._UA.�i� ten-. D� .• -� ._.. s � �C ...---•---•----•-•............ ........................................................................ r'r .-• •----..---•----•- ------------------- - -------------- ---------_.....................--................_...__.__._.___._........................... (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;Dlstrict. 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, l 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 than owner) _ _ .,„_ _._.FOR_DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ---- -- -- ------------------------------- ------------ DATE ................... BUILDING PERMIT ISSUED ---- -----------------------DATE ._.. ._.._........ ...... ......... ADDITIONAL COMMENTS ----- ---------- -•-------------------------•• - ---------------------------------------------- -------...--------------- -----•-------------••---•----- ----------------- ----------------------- ---...-------------------------------------•------------- --------------_------- •---•----------------------- -------------- 8 --•• . - Final Inspection by: ..---- ------------------ _ - 2 `�' Jte - SAN .JOAQUIN LOCAL HEALTH DISTRICT 8/74 3M