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FOR OFFICE USE: _ APPLICATION FOR SANITATION PERMIT ------ -- --------- -------------- -Permit 44o. ----7�:-�4 {Completein Triplicate) -------- ---------- ----------------------- ------------ --------- This Permit Expires 1 Year From Date Issued 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: JOB ADDRESS/LOCATION .------7'05 -----woo �eA!fP-------AUS-----------------------CENSUS TRACT --------------57...... Owner's Name . �C��LGIf✓w� �> �rJYaU- ,1�------ -----= g �3 lis._-• -------- Phone Address -- �J- ------ a•__f A-PGG------------------------- Cit /W�T!FG,q Contractor's Name ......Ai_4•---1:7_6)Z46�---------------------------------------------License # Phone ----------_-----_ -- Installation will serve: Residence •Apartment House❑ Commercial ❑Trailer Court ;❑ Motel ❑Other _________. _ Number of living units:--- ___--__ Number of bedrooms ___ ______._Garbage Grinder - ---------- Lot Size _._�___,x -------"s_____________ Water Supply: Public System and name -------------------------------------------------- -----------------------------------------------------------Private 0 Character of soil to a depth of 3 feet: SandV Silt 0 Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ Hardpan ❑ Adobe ❑ Fill Material ----------_ If yes, type______________________--__ (Plot plan, showing size of lot, location of system 'n relation to wells, buildings, etc. must be placed on reverse side.) NEW INSTALLATION: (No septic tank or seep a pit permitted if public sewer is available within 200 feet,) /l C1Q PACKAGE TREATMENT f ] SEPTICTANKf Size_ o1v2--------------------- Liquid Depth ____a_-3------------- Capacity Type _PP�_61:�/ Material---------------------- No. Compartments ----;;�---•-•-•----- Distance to nearest: Well __ > d__-________-______________Foundation _Arl______________ Prop. Line ___-____.;�:___________ LEACHING LINE No. of Lines ____3--------------- Length of each line-----9,3---------------- Total Length f g�---........_... 'D' Box ---/------- Type Filter Material -__Depth Filter Material ----- ___________________•____.- Distance to nearest: Well —6-0-------------- Foundation __t v__________ Property Line _________________ ______ SEEPAGE PIT [ ] Depth ____________________ Diameter _______________ Number ---------------------------- Rock Filled Yes ❑ No i❑ Water Table Depth ------------------------------------------------Rock Size ----------------------------•--- Distance to nearest: Well _____________________________ _ ________Foundation -------------------- Prop. Line ---------.--__ REPAIR/ADDITION(Prev. Sanitation Permit# .------------------------------------------- Date ----------------------------------) SepticTank (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 t orkman's -Compensation laws of California." Signed ---------------- Owner BY -------- ------------------------------------------------- -------------------------------- Title ------------------ - ---------- ----------------- ------------------------------------ (if other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY --r------------------------------------------------------------------------- DATE -----3-----;?1.`--73--------- BUILDING PERMIT ISSUED ------------------------------------------------------------ ---•------------------------ --------------DATE ---- -------------------------------------- ADDITIONALCOMMENTS ------ --- --- - ------------------- --------- --- ---------------------------------------------------------------------------------------------------- --------------------------------------- ---------- ----------------------- -------- ------------- -------- - ----- ----- - --- ----------------------------------------------- -- --- ---------- - -- -- - --- - - Final Inspec __Date ____. ___"' SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M