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FOR OFFICE US 14 APPLICATION FOR SANITATION PERMIT � , y, ---------------- -- Permit No. -- (Complete in Triplicate) ---------- 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 No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION __4-0�--- --7._1V---_��_----- - ----------------------------------_--------CENSUS TRACT -------------------------- Owner's Name -------- ------------- --------------------------------------------------------------- ---Phone ------------------- ................ Address ------ 1 117 ---p---------------------------------------------------------------•--. City - 1 --------------------------------------•------ Contractor's Name -----/ ' -L_ ._�ze,P_vrf-----------------------------------------License #11-f-- Phone . - ` Installation will serve: Residence 4 Apartment House,❑ Commercial ❑Trailer Court 0 Motel ❑Other ----------------------- ---------------- Number of living units:--- ----- Number of bedrooms ___�l__-__----Garbage Grinder Lot Size --`__'_-._____-•-_. Water Supply: Public System and name --------------------------------- --------------------------------- ,------_--- -------------- ---------Private Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam Hardpan ❑ Adobe [t Fill Material -- Fill 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: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) i , 00 PACKAGE TREATMENT [ ] SEPTIC TANKSize__ ._ _��__, ___y�`'___.____.__-___ Liquid Depth _ Capacity /x_ _ _. Type /-O'4- Material_ 'QnG_ ----- No. Compartments __-2.._...__...._ Distance to nearest: Well __,�Q�__`___________________Foundation p------------- Prop. Line ----------------_---- LEACHING __-____- _-___._--_-LEACHING LINE No. of Lines __________ _ f f �_ __________ Length of each line___ f_ ____._-_____ Total Length ,.J�_�__________________ \11 'D' Box _�{/( _ Type Filter Material/-.3.A epth Filter Material 1e,.> Distance to nea`st: Well -9-Q-s--_-______� Foundation %_oP_ ___________ Property Line ........................ SEEPAGE PIT [ Depth __02__•�___-_-_ Diameter ;?Iy------ Number ________/________________ Rock Filled Yes ;ff No 0 Water Table Depth ------ ----_______________________________Rock Size __1---.3_ ___-___--__ Distance to nearest: Well -----------------------Foundation ---n-T47."_ Prop. Line ------------------••-- REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- 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, 1 shall not employ any person in such manner as to become subject to Workman's Compen tion laws of California." Signed ---- --- -- --------------------------- ---- - ----- -------------------------- Owner By --------------------------- - -- --------Is'� ----------------------.- Title ----- / _, --- -- --- -------------------------------------- (If o than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY -----NZ•---- -------NJ 0'4-k DATE --------J`- -9A- --------------- BUILDING PERMIT ISSUED -------------------------------------- - -------DATE ------------ ------------------------ -- --------------------------------- ADDITIONAL COMMENTS ----------------------------------- _ ---------- ------------- - ---------------------------------------------------------------------------- - ---------------------------=------------------------- - ------------------------------------------------ -- ------------ - ---------- ----- --------------- Final Inspection b _ t� tb_Ei__ _. ---__ P y: -----------------W_ � ----------=-------------------------- Date SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M