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fOR OFFICE USE: APPLICATION FOR SANITATION PERMIT --------- ------- Permit No: 9_= 4__� (Complete in Triplicate) r Date Issued -_Y__ f-fa , _,_ '-4-l -_-____-- This Permit Expires 1 Year From 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 _ -�,_-_- -,9AIA-------- ---------------------------------------------------CENSUS TRACT -------------------------- Owner's Name ----/9 if v � --------------------------------------------------- -------Phone J- 4 ---- Address --- �.�J-�1� --------- -------------- ---- -------•--. City ---------- -- ------- Name ,. . ply - 1License # I77. 3 Phone Installation will serve: Residence ❑ Apartment House❑ Commercial ❑Trailer Court El Motel ❑ Other -- ----------- ---------------------------- Number of living units:---- Number of bedrooms - -------Garbage Grinder ---rfV__ Lot Size -------- Water Supply:Supply: Public System and name ----`------------------------'" ------------- --------------------------------------------------------------Private-E] Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat ❑ Sandy Loam ❑ Clay Loam ❑ Hardpan ❑ Adobe P-- Fill Material ------------- If yes, type ---------------------------- Plot ---------------- --____Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) GI; NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [/}-- SEPTIC TANK[ J Size. ---------/ -------------- Liquid Depth -_--____-___-.----- Capacity - Type Material_�¢>u_C T Y No. Compartments —2.--------------- V. Distance to nearest: Well / _Foundation __ --�--�_-______ Prop. Line ----- 1 f LEACHING LINE [-Pj--�No, of Lines -----/------------------ Length of each line_______ ___-: ------ Total Length ------�!,1 ___ -__-___--_ 'D' Box ------------ Type Filter Material __- 4_ ___Depth Filter Material ___ ......_______________.__--.-_._ Distance to nearest: Well __ G__ ---------- Foundation ------L_47------------ Property Line, -------------------- SEEPAGE -_ `-- _.--__SEEPAGE PIT Depth _a2- --------- Diameter Number --------------------- ------ Rock Filled Yes [2 No i❑ Water Table Depth ----JA!q-----------------------------------Rock Size -------------------------------- _ t � Distance to nearest: Well ....1-0-af______________________Foundation __-_ Prop. Line ----f_.________ REPAIR/ADDITION(Prev. Sanitation Permit r# ------------------------------------------.- 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 become blect to Workman's Comp ensation laws of California." ------------------- Signed - ---- -T � Owner €: By ------------------ ------------- -a owner- ) 7itfe - I (If other than ownerner)-------------- --------- --------------- i FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ---r-e_d._._ CLr� ----------------- DATE ----- -------- a BUILDING PERMIT ISSUED -------------------------------------- 1 ` ---------------DATE ------- ----- ------------------ --------- ADDITIONAL COMMENTS -------------------------- ----------------- --- -- --- -.. W-3-i'-49 wy --------------- 4 '------- ------- ---- -------------------------------- ------------- -------- --------- - --------------------------------zl=----------- -------- _ Final Inspection b J P y: -- - ---- =-------- " ---------- --------------------Date N JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev."5M