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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT --------------------------- ---------------- - --- ( . !% Permit {Complete in Triplicate) 3t?2-------- --- ----- ------ Date Issued .�_:-1(__.7 ------------- This This Permit Expires 1 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 plic ion ma ',e " :compliance with County Ordinance No. 549 and existing Rules and Regulations. - . JOB ADORES�LOTIONI7� s--- ---r�eJ,./1-1r:Tj41--D� -4-J"O%NV S TitACTU_._��------------- Owner's Name -- ___ r7?- �-----------------r�-C-�°� -'L' ------ -------------------Phone --------------------------•--------- Address ------1---� �'� �F p i �--------------------------"--"_". City _ , J U Contractor's Name --------�'-l- _ 7-----_-a. _ ---- ------License # Phone Installation will serve: Residence partment House Commercial❑Trailer Court i❑ Motel F-1 Other ---------------------------------------=---- Numberof living units:_____.____ Number o edrooms ____:_Garbage Grinder �� __ Lot Size - _-- / Water Supply'. Public System and name 4 2'a --------------•--•------------------------------------Private ❑ Character of soil'to a.depth of 3 feet: Sand'❑ lilt❑ Clay ❑ Peat❑ Sandy Loam -❑ Clay Loam Hardpan ❑ Adobe i I Material Z _ 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 Sir---- S _ Liquid Depth ___ /------------._ 6pacity Type _ Material Flo. Compartments Zr p ---------------------- - Foundotio .__O. -� -Distance to nearest: We11 ____.-_ _ -- --------•---__-- ra�G ------ ___-- Prop. Line ---------------------- � LEACHING LINE No. of Lines ___._c _-___________ Length of a ch line____. Gt Total Length a 'D'--,Box ._�G_4 " Type Filter Material �!7��Depth Filter Material ---------------------------------- Distance.�to nearest: Well _________ ----- Foundation .rd_/_ -------_-- Property Line f___-------- SEPAGE,P1T [,}� Depth ------- Diameter Number .___-.� _ ____ Rock Filled Yes ❑' = Water Table Depth --------------------------------------------------' _ _ _ / - . ._ Rock-Siie -' I Distance to nearest: Well ------- -Foundation __,/a_.._.____ Prop. Line "s/____-__.__ REPAIR/ADDITION(Prev. Sanitation Permit=# -------------------------------------------- Date _________________________________} SepticTank (Specify Requirements) ------------------------- --------------------------------------------------------------------------------------_ ----------- DisposalField (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 (tulles 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 j BY = ---- -- ---- -- ------------------ ---- Title ---- -�-- ------------------------ (If of r an er). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY _._T- -- _ -- -- -l}__�-- ---_s�_-✓ --------------------------------------------, DATE -----7___.---- BUILDING PERMIT ISSUED -- -=------------ ------I------------------------- --------------------------------------DATE - -------------------•---------------- -- ADDITIONALCOMMENTS ------------- ------------------------------------------------ -------- -------------------------------------•------------------ ------------- -------------- �P --- ----- ---------------------------------------------------------------- -, ----- ----------------- - -------------------------------------------------------------------------------------- -------- --------- ------------•- --- -"- `-- . � - - -- --- ---- ,-- -- - - -------------------------------------- - --- ----------------- ---- --------- --- -- - Final Inspection ________________Date __ _ P y ; - / _" AN./JOAQUIW HEALTH DISTRICT ] V E. H. 9 1-'68 Rev. 5M }