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FOR OF RICE USE: APPLICATION FOR SANITATION PERMIT a T - ] ----------------------------------------- (Complete in Triplicate) Permit No. _._7�=_3-35 ' ---------=-- -------------------------------------------- /�]/ This Permit Expires 1 Year From Date Issued Date Issued __'S�________.___. Application'-:is hereby made to 4he San Joaquin Local Health District for a permit to construct and install the work herein described. This application is m6d,6 in compliance with County Ordinance No. 549 and existing Rules and Regulations: t JOB ADDRESS/LOCATION ---,Y17_[_b--___�------t+V - - ------CENSUS TRACT _ �______._ Owner's Name --------I' = 4---------- –= t; ,, = -� -------Phone -"_` �---- �__' V -�---------- �i�?c C,_C 4.U.i ----- ----------------. city 1.-Cy Address __-------------------- /,z 1 �r Contractor's Name --------0— -t.---t_`-0-f f-1-e---------------------------License #P Y ��- Phone CJ--�' Installation will serve: Residence [] Apartment House-[:] Commercial ❑Trailer jjCourt ;❑ Motel;❑� Other --------------------------------------- j ---- ------------ ----------------�f f Number of living units:---__-_--- Number of bedrooms ________Garbage Grinder j__ -� Lot Size -._ � Q-_ _____________ } I k / 1 Water,Supply: Public System . nd name_ ---------------------------------------- - ------------ ------- -----�.---------- - --------• - -Private Character of soil to a' depth of-3 feet: Sand'g�',, Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam P ^ 1� Hardpan ❑ ``Adobe '0 Fill Material _._- -- If yes, type -----------------/__.______ E (Plot plan, showing, siie of lot,'+,location of systeffi in relation_to-wells buildings, etc, must be placed on reverse side.) NEW INSTALLATION: (No septicItank or seepage pit`4permitted if public sewer is available within 00 feet,j PACKAGE TREATMENT. [ ] SEPTiIC,TANK:[ J Y. Size------ ----------------------------------------- quid Depth -------------------------- Capacity ___ ------------ Type ------------- aterial---------------------- No. Compartments ? Distance to nearest.,est: Well ---------------------- ------------Foundation ..__ ----- ----------- Prop. Line ---------------------- 1 k M1 LEACHING LINE [ J No. of Lines __.______.__`_ Length of ach line____- __._.._-___ Total length -----------_________________ Type Depth Filter Ma eriai --------------------------------------------- 0 _________ __ __ 'D' Bo�c:: ' - T e Filter Material --- - ---- --- -------•------------ ---- u -- -- Foundation ------------- Property Line. ------------------------ SEEPAGE ------------------- - i�. C--Distance Jo. nearest: Well ________________._ - -- SEEPAGE PIT, [ ] Depth `�-___________ Diameter __________ _____ Number ___--.-.-_--___-_ ______ Rock Filled Yes ❑ No 0 i �. Water Table Depth --------------------------- --------------------Rock Size ------ ------------------------ A, -; ' e, ; Distance'to nearest: Well __________________ _____________________Foundation . ___.__----------_- Prop. Line ----____•-______..__.. REPAIR/ADDITION(Prev. Sanitation Permit# ________________________________ Date ________-__._____________________j ,� Septic Tank (Spec-IT Require�merits) ---------------------------------------------------------------------=------------------------------------------- -. -- Disposal Field (Specify Reg6rements) ------------------------------------------------------------------------------- ------------------ ------------- - /�V ,x-�'�X .l :�/ j1 - ��__�- -------------- ----_. LOf�T l��11__------ - 1 i --- - ----- ----t'---------- F. -- �rvl P �� '(Draw existing and required addition :reverse side) I hereby certify thatgl have prepared this application and that the work will be done in accordance with San Joaquin F County Ordinances, State Laws,.and Rules and Regulations of,the San Joaquin local Health District. Home owner or licen- sed agents sig'natureacertifies 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 subject to.-.Workman's Compeaotion laws of California." ry v1 Signed --� --- -- ------ =} Owner F r L ��j B �---------- =---=-=---- ----'�---�/------------------------ =Title ---------- --- - - --- -----' --------------------------------- y (If other than owner) �� FOR DEPARTMENT, USE ONLY p APPLICATION ACCEPTE15 'BY?-.---a- --=(_)RLJ�__-- --------. DATE ------ -----"'-.--- BUILDINGPERMIT ISSUED ------------------------------------------------------------------ ---- ------------------------ --.DATE ADDITIONAL COMMENTS -------- --' - -- -----------------•-------------------- ----- ----\-:----------- ------ ------------------------------------------------------------------------------------- ------ ---------------------------------------- ----------- - -------------------- ----------- ----- -- ------------------------------------------------------------------------------- ------------- -------- ----------------------- - --- ---------- ------------ - ----------- ---------------------- ------------------------------ ---- ---- - ------------- - -- - ---- ---- i Final Ir�peet�era-bY. ---- --- ---------- ------ Date -- --------------- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M