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EOR OFFICE USE: APPLICATION FOR SANITATION PERMIT 1 Permit No:�?_0._-6_l -- ----------- -- ------------- - 4 (Completein Triplicate) ------------- ------------- ------------------ G -------------------------------------------------------------------------------- ------- L) (This Permit Expires 1 Year From Date Issued bate Issued --------------- ' F ; �I 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 .. f^ n c�2 _,- 1 m ----SA< c�-�------------- _CENSUS TRACT .------------------_---- y,e"(�-2 ?/ Owner's Namee'�, f �c�j�llPN__ C�. Phone -- - -------------------------- -------- -- ---- ------------------- Address ------------ Cit y 1�(J/----�-- ---�------------------------------------- Contractor's Name _ctL' Lt°.___.______L �`'.________ -- License # "`�/�3_ Phone 614�4_� Installation will serve: Residence ❑Apartment House,C] Commercial ❑Trailer Court ❑ "-„ Motel XOther ---------------------- Number of living units: Number of'bedrooms -__________Garbage Grinder ------------ Lot Size _____________________________________--.-.- Water Supply: Public System and name ------------------------------------------------------- -------------------- ---------------------------------Private Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Gay ❑ Peat❑ Sandy Loam ❑ Clay Loam.7 Hardpan ❑ Adobe Fill Material ---- ------ If yes, type ------_____________________ (Plot plan, showing size of- lot, location of system in relation to well s,!buildings,,etc. must be placed on reverse side.) NEW INSTALLATION: {No septic tank or seepage pit permitted if public sewer is available within 200 feet,j PACKAGE TREATMENT '[ 7 SEPTIC TANK --;Z4/�-'�-------- Liquid Depth --,�z/------------- - --� ' .----- Capacity _, .-- Type ______5/-Material_C'411-G----- No. Compartments ------------y-,-----,--- Distance to nearest: WeII -----__--------__--_-__Foundation _.,�1�--------- Prop. Line LEACHING LINE No. of Lines - �___________,_ _"Length of h line__/1�-�----------- Total Length ...... __ 'D' Box __ :_'- Type Filter,Material -Depth Filter Material __,A6_?_,-___________________________ Distance to,nearest: WeII� Q_"°” - --- Foundation !___�e-____------ Property Line _�-_ ----- De' �-f�!!.---- i a �f R / _______ Rock Filled Yes NO SEEPAGE PIT T Depth --/-- -:---__-- Diameter - ---�------ Number ---------5_-__ .` Water Table Depth ------�5 --------------------------Rock Size ` r -Distance to nearest:-Well�J-4___ ___ ________________Foundation Q--r___ Prop. Line REPAIR/ADDITION(Pre`v. Sanitation Permit# -.-----.--------------------------------F- Date ------- SeptiSeptic --------------------------------------------------`-�----•---��-- c Tank [Specify Requirements) ------ ------ ----------------- - - --------------- n„ Disposal Field (Specify Requirements) ------------ ------------------------------------------------------------------- ----------------------------------------------------- --------------- I -------------------- -------------------------------------------------------------------------------------------------------------- ----------------------------------=---------=--------- , -------------------_---_------------_-----------------_____.___.__---------------------------------------------- ____________-_---_------___.________-___________________----._._.___-___-._-_._ _ - + (Draw existing and required addition on reverse side) I hereby certify that I1 have prepared this application and That the work will be done in accordance with San Joaquin �' I 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, 1 shall not employ any person in such manner as to beteg subject toWor an'Compensation laws of California.'. ' Signed _.. � 1 { �� - ' --- __ Owner _ .� BY ------------------ - - - - ��-`--- - -- -- -� 1L--------- Title ---- -- �--- - - --- ----------- -------- ------- � -------- (If other than er) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY -----P/----- -----------------------------------------------------------------• DATE ---- V/ --------------- - BUILDING PERMIT ISSUED ------- ----------------------------------------------- ="----------- --------- ---DATE --------------- ---------- ------------' ADDITIONAL COMMENTS ---- ------ o- ----=---- --------------------- - SA Gam ' ----------- ------------------------------------ l� .�P----'----- -------`------------------------------------------- It -------------------------------- ----------------------------------- - - ------------------------------------------------------- ----------- ------------------ Final Inspection by: ..' ----------------------------------------------------------------------------------Date SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M •. �• R �r� .�.. �. �� .t1