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FOR OFFICE USE: APP111CATION FOR SANITATION PERMIT -- --- - - , Permit No. ----- 7--- � 6 (Complete iri Tripliedte)' -------------------4S--1--(----------------------- 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 Nb. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION ___Yl___ -----------,---------------- ----CENSUS TRACT •------------------------- Owner's Name ----f = u- -zc_-- 7--------- -------Phone _ Address ------------------------------------ - Citrt -- - Y %• s� / �+ Contractor's Name ___ x'_ `.__ �2� - _ ____ter-�+___------------------License # 244= -9-J7__ Phone __(�--3_�_^-1.1.4 1 Installation will serve: Residence Apartment House❑ Commercial ❑Trailer Court I❑ Motel ❑Other -------------- ---------------------------- 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 ❑ 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: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK'{ ] Size__ _________ Liquid Depth -_______________________ Capacity J-2-0-01_______ Type Material__avAt r __ No, Compartments __ .__._ _ Distance to nearest: Well _______5-_t -------------- -------Foundation -------J-�_______- Prop. Line __.___.5________- LEACHING LINE [ ] No. of Lines --------- ..________--_ Length of each line------ _>______._____ Total Length ------1.9Z.............. 1— - 'D' Box - Type Filter Material ____ 1._ _____Depth Filter Material __ °__1!'_______•__ . ____-__ Distance to nearest: Well _____ �___________ Foundation ------l_r---------:___ Property Line ____' ............ SEEPAGE PIT [ ] Depth ___ "____ Diameter V�_'Y_f_D___ Number _ -)------------------ Rock Filled Yes Al No i❑ Water Table 'Depth ------------------------------------------------Rock Size -------------------------------- Distance to nearest: Well ----------------------------------------Foundation -------------------- 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, I shall not employ any person in such manner as to become subject to Workman's Compensation laws of.California." Sign�eedf----------------------------------------------------- -------------------- ------ Owner BYE rr- Ka-- ----------------------------------- Title --------------------------------------- -------------------------------- - - (If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ____-__=� ___- __ _____ DATE ___��_-/<_'� _.._•__.__. BUILDING PERMIT ISSUED ----- ------------------------------------------------------- ---------------------------- -------- ----DATE -------------------- ADDITIONALCOMMENTS -- ----------------------------------------------------------------- --------------------------------------------------=-------- ------------------ --------------------------------------- ----------------- ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- -----------------------------------------1-------------------------------------------------------------------------------------------------------------------------------------------------------------- ----- - -- --- `" -- ------ - - -------- --------- -- - --- /� --- - Final'Inspection by: --------------- - --- ----��- C.Y-- --------------------------I-- ----- ---- -----------Date -! -7 --- -- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M C