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' FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT 4 ------ ------------------------------- Permit No. 11.77 �`D.. - - - - (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 per to construct and install the work herein described. This application is made �in compliance with Cou"nnttyy Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION . .---_ -14`-l EJ ,------��a'�-B -I �-------------------CENSUS TRACT --------------•----------- �! p Owner's Name ------------ --,�-----_r � —�-- -----------------=-•----------- -------Phone ----------------------••---•-------- Address --------------- r r��J�' L1 , yc.�r,� /70( City ---- noe-`------------------------------------------------ ---------- .... Contractor's Name �Ll . icense # ��,� .� y--- Phone -----------•------------- --- Installation will serve: Residence EN/Apartment House°0 Commercial ❑Trailer Court C] Motel ❑ Other ------------------------------- ------------ Number of living units------- Number of bedrooms ___Garbage Grinder ------------ Lot Size ------ —_______ 1 Water Supply: Public System and name ----------------------•--------------------- --------------------------------------------------Private Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat❑ Sandy Loam`❑ Clay,Loam I Hardpan ❑ Adobe❑ Fill Material '----------- If yes,type ----------------------------- (Plat. '_______________________ _(Plat.plan, showing size of lot, location of system in relation to wells, buildings, etc. must bel,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[;1' x__S._i_____ Liquid Depth -_�____________________ � I Capacity - _ Type __ Material__ -�__-_ No. Compartmentsv�.-__-___:.... Distance to nearest: Well ---------SIC---------------------Foiundatibn_._,�-0___________ Prop. Eine ___.--__________-___-_ j LEACHING LINE [�No. of Lin_es ------ _________ gth of each line---L......? _____rTotal Length r � Len D- Box __ 1 . ' -- -____-- Type Filter Material --�--r?-�-------17epth Filter Material -------'��-+s------------------•------•- Distance to nearest: Well __----_-XQ--.________ Foundation -----L-v-_`_-_________ Property Line. ___________________ °SEEPAGE PIT [ ] Depth ___ _______________ Diameter ---------------- Number ---------------------------- Rock Filled Yes ❑ No vi❑ 1 Water Table Depth ------------------------------------------------Rock Size ----------------------- k Distance to nearest: Well ----------------------------------------Foundation -------------------- Prop. Line -------------- ---.-• � t REPAIR/ADDITION(Prev. Sanitation Permit# ------------------------------------------- Date ----------------------.-----------I SepticTank (Specify Requirements) -------------------------------------------------------------- --------------------------------------------------I----------------------------- ✓ Disposal Field {Specify Requirements) _____________ ------------------------ __________________________________________________________________________..____ ________________________ -________________________-____-____-_-_____________-___________--------_--________________________________________-------___._-_________ ________ k ' (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 P subject to Workman's Compensation laws of California." iSigned ---------------------------------------------�[��---------- --------------------- Owner kBY ----- -------------- - `�( '�` ` Title -- --------------------- ------ (If other than owner) FOR .DEPAATMENT USE ONLY APPLICATION ACCEPTED BY =-- -- - - �----- --------------- DATE --- - .................. BUILDING PERMIT ISSUED -----------'------------------------------------------------------------------------------- DATE -------------------- ------------ - ---------------------- ADDITIONALCOMMENTS ----------- --------------------------------------------------------------------------------------------------------------------------------------------------- -- ------ ::- - -- Final Inspection by - ----- ----- --- -----.Date ----- -- -- _` � SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M.