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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No: ------------------------------ ----, -------- -------- (Complete in Triplicate) Date issued /�- �'7- -- ----- --------------- ---------------------------------- 111; This Permit Expires i Year From 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. n4 J s e. JOB ADDRESS/LOCATION . _�_ % F = / +----- Jr-----9_��w/---CENSUS TRACT Owner's Name ----ChV_CA-----------5AA-Y_�_d_fl_- -------------------Phone A`3`------------4 AddressCit ------------------------------------------------------ Rw�- � $" �?/ Contractor's Name --. ------------ ------.License #/... --- Phone Installation will serve: Residence IA Apartment House❑ Commercial :❑Trailer Court l❑ f Motel E]Other ---------------------------------------- Number of living units:___.!_---.- Number of bedrooms A-------Garbage Grinder /Yk----- Lot Size -------------------------------------------- Water _______________ _---________________----Water Supply: Public System and name ---------------------------•._ ------------------------------------------Private,® t Character of soil to a depth of 3 feet: Sand Silt❑ Clay ❑ Peat ❑ Sandy Loam •❑ Clay Loam '❑ Hardpan ❑ Adobe,M 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,) __-Li Liquid Depth __.V------------------- ! PACKAGE TREATMENT { ] SEPTIC TANK,[ ] Size______________________________________________ q P fib T e/40-IAS/Material____6a44�---- No. Compartments ,_ __�.....__._._. Capacity -- -----------•-- YP Distance to nearest: Well ----------�6-----------------Foundation ...la------------- Prop. Line--...----------- No. of Lines --------- - j Depth Filter 01 Material ____________ ______________________________ 'D' Box .____ -_.___ Type Filter Material _______;�_____ ___ Distance to nearest: Well ___-_a�--------- Foundation --_.A07------------ Property Line 4Q----------------- SEEPAGE PIT [ ] Depth -------- ----------- Diameter ---------------- Number --------------------- - ---- Rock Filled Yes El No iGt Water Table Depth ------------------------------------------------Rock Size ---------------------------- Distance to nearest: Well ----------------------------------------Foundation -------------------- Prop. Line .---------'---- ----- REPAIR/ADDITION(Prev. Sanitation Permit# -------- ----------------------------------- Date ----------------------------------) 4 S Septic Tank (Specify Requirements) ------------- -------------- --------------- -------------------;;•._ _______________________--_•._____________-_________--___ ----------------------------------- Disposal Field (Specify Requirements) ------------- ----------- ------------------------------- ----------------- ---- --------------------------- - - ----------------------------------------------- } (Draw existing and required addition on reverse side) 1 hereby certify that 1 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." Signed �9�7 -------- -- N Owner Title --- -------------- -------------- ------------------ BY ! (If othe er) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ------ ---'---`' DATE -�-W,- BUILDING PERMIT ISSUED ------------------ --------------DATE ADDITIONAL COMMENTS ----- ---------------------- -- - -------------- ----------•---------------- ------------------------------------------------------------------------------------------------------------------------ ------------------------------ ------------------------:---------------------------------------------------- ------ -- - Final Inspection b Ji ------- - ----=------------ --Date - ---------- ------ SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M