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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT �'/' -7 3, i. Permit No. -12 --- --- Y r p= � /��-sd (Complete in Triplicate) ;. �- Date Issued ---- --------------------------------------------------- This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Health District for a per to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: ___.CENSUS TRACT __-___ JOB ADDRESS/LOCATION .----/"�v .----- --- t ------------------- --- -- ---- " Name ----- /?�/ °��' ------- Phone / - ------------------------------------ Owner'sAddress -- ----- ice -------------------------- --- CitYa/ �/� Contractor's Name � Z APLS-\�--- ----- ------------------------------License # l l -- Phone ---7: _ Installation will server Residencee❑Apartment HousCommercial ❑Trailer Court 110 Motel ❑ Other -------------------------------------------- Number of Iiving.units:___-1----- Number of he oms __ ___ Garbage Grinder '� .__ Lot Size . 41-_", - y, ------------ Water Supply: Public System and name Private E] Character of soil to a depth of 3 feet: Sand'E] Silt'❑ Clay 0 Peat❑ Sandy Loam ❑ Clay Loam 924 ' Hardpan ❑ Adobe ❑ 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.] \ NEW INSTALLATION: i (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK e -__- - ------------ ------ Liquid Depth ""- /----------- Material No. Comp --- --- a D Compartments ---- ------------ 4 Capacity _ _��`� Type ' Distance to nearest: Well ------------------------------------Foundation ---1-d--/_-___ Prop. Line --�---------------- LEACHING - -----_ - ------------- Len /+St /+r------ Total Len /i f LEACHING LINE: [�' tiNo. of Lines "________ Length of each line. __ gtk.-- ----------- ...... p i 'D' Box A,_$--- Type Filter Material 1y%_�_______-Depth Filter Material _14P---------------------------------•- Distant to nearest: Well _________ __________ Foundation ___; - ----------- Property Line S.=____ ___--___-_____ __ Rock Filled Yes ' No SEEPAGE PIT [� Depth _C�1��---- --- Diameter 3_3------ Number ----�..�_--_--_--- � �jrU j k Water Table Depth %-- ----------------------- Rock Size /! - EV- i Distance to nearest: Well --------------- ------Foundation ----------- Prop. Line 47�__.----------- ^ REPAIR/ADDITION(Prev. Sanitation Permit# --------------------- -------------------- Date ---------------------------------- �1 q .. SepticTank (Specify-Requirements)----------------- --------------------------------------------------------------------------- -.-----------------I----------------------------- Disposal Field (Spe iify Requir Lents) ------------ -------------- ------------------------------------------------ --------------------•----------- j % ----------------------------------------------------------- ----------------------------------------------------------------------------------------- --- -- ------ i ` ---------------- ---------- ----------------------- ------------------ ! (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 liven-,{ 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 i as to become subject to'Workman's Compensatlan laws of California." 1 Signed ----- --------------- -i--- ----- --- -- -- -- ------ - ---------------------------------- Owner By ----------------------------- ----- _-------------------- Title ------------------- G�fl1r,' (If `than owner) , ENT USE ONLY { DATE --------- ,/f �APPLICATION ACCEPTED BY --- -------- -'�--- --- -- ----••-- - "- --------------------------- --• -- - - -� ---- BUILDINGPERMIT ISSUED . -- -- -- ------------------------------- - --------------DATE --- --------------------------------------- DDITIOoNALCOMMENTS ----------- ----- -- -- ------ ----------------- - ------------------------- ----------------------------------------------- 7- -- ---- --- - -------------- -------------------------------------------------------------- ------- -------eel- ------ - ----------- ------------------- ----------�------ --------------------------------- ---------e--------------------------- Final lrfspection by t ---------------- ---------------_I.,---------- ---------------------------- to ------ ' 9 Q AN OAQUIN LOCAL HEALTH DISTRICT . E. H. 9 17'68 Rev. 5M