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r'VK !Jrt'IC.t UJt: APPLICATION FOR SANITATION PERMIT - - - - _ - Permit No. ----�=--� •- �-/ y (Complete in Triplicate) This Permit Expires 1 Year From Date Issued '.7__ Date Issued __l�. 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: JOB ADDRESS/LOCATIOc� -/C��/l�-�-----.i- --- � -- - -�-'`"'�c:�-- ?�4r<-- - - - -.CENSUS TRACT .. - - -------- Owner's Name?-tri . -�``cr-' ------------------ -- -------------------------------------- -- -- Phone - Address C � 'L1tG 11� Ci ----- �----------- ----------- ------------------------ ------- - ------- Contractor's Name - ..License # - -3 __ Phone - Installation will serve: Residence Ef Apartment House❑ Commercial ❑Trailer Court ;❑ Motel ❑ Other _---L C tti ? ,,-y Number of living units:---- Number of bedrooms _,.3-------Garbage Grinder _-- --- .. Lot Size Water Supply: Public System and name ------------------------------------------------------------------ - -- -- --- ------------------------Private � Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ Hardpan Z 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 ifRublic sewer is available within 200 feet,) y PACKAGE TREATMENT [ ] SEPTIC TANK Size_,$-_,,,.-y/.�._�_..-_.--_--_____ ----. Liquid Depth .-s--------------.----- - p Capacity /`.- --- -- e - ------------- Material---- -------- No. Compartments ---------------------- Distance to nearest: Well ---__. --- ._ ------ --- ------Foundation .... ---__------_____ Prop. Line -__-._..___.____..__ LEACHING LINE [ ] No. of Lines _.__ __ _. ____ Length of each line__ __-.__ -___ Total Length -----------__ d --------------- 'D' Box .._ __ Type Filter Material --------------------Depth Filter Material __.____-_____-._-______._-----___-._.--_ Distance to nearest: Well ._______--__.___- Foundation ___.--__._ - _ Property Line .-_____________________ SEEPAGE PIT [ ] Depth __ _-- Diameter ________________ Number - __ ----- Rock Filled Yes ❑ No Water Table Depth --- -- -------------------------------.Rock Size .--- - -- ---- ------------- Distance to nearest: Well -------------._------- ----------------Foundation ------- Prop. Line ---- --------......... REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------- -- -- - Date -----.----------------------------I Septic Tank (Specify Requirements) . - ------------------------ -------------- ----------- - -------------------- -- - ------------"---__--------------------------- Disposal Field (Specify Requirements) ��__�. -a-- "----- = - r te •�: y-_-_------ -< `__ ' l�r...E- +_ /L- GItA �c+w--c� iC.JGeL'� 1--- -= ----- � ----------------- -------------- --- ------_--------- (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." Signed --- ------- - - } Owner _ 9-��t Title .. ---------_---------------- ------------------- (If ------ -- (If other than owner) FOR DEPARTMENT USE ONLY 7/ APPLICATION ACCEPTED BY _. _ '`'"t` -------•--- ------------------- ----------------------------- DATE _r BUILDING PERMIT ISSUED ----•---------•---------------------- ----------------------------DATE ------------- ---------•----------- ------- ADDITIONALCOMMENTS .-----•----------------•-•-•----•----------------------------------•--•-•----- --------------------------------------------------- --------------------------- ----••----•----•----------------------------•-----•-----------------•--- ------- -------- �---------- ;f=- ---- r..,- ----------------- --------------•-- ---------------------------- ----- ,; ;n ---, Final Inspection by: `='--=r ,--•--------••------------•--•--- ----•--- ------- Date �'" SAN JOAQUIN LOCAL HEALTH DISTRICT F H 9 1-'68 Rev- 5M