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FOR OFFICE USE: ,") APPLICATION FOR SANITATION PERMIT `------------------y=. ... ��7 (Complete in Triplicate) Permit No. ...................... -----.-_.._--_.-.-.-...__._......_...-..-_-...... This Permit Expires 1,Year From Date Issued 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 e(Jisting Rules and Regulations: JOB ADDRESS/LOCATI N y &7 .�r ._... ....�J(��l�fy/_.�Z�/r.. �jG..CENSUS TRACT -...._--------------_. Owner's Name --- /y -^ - -: ..Phone -- ------------------------ ------ Address ------------ City Contractor's Name ..--- (�--..._.............:........License #��s��l�Z- Phone Installation will serve: Residence Apartment House C❑ Commercial ❑Trailer Court i❑ Motel ❑ Other ----------------------------------------- Number of living units:----C-----_ Number of bedrooms _0/..-.Garbage Grinder .Str" Lot Size ------._-..._-. Water Supply: Public System and name --------------_. ---------------------------------------—----------- ---------------------------------------Private19 Character of soil to a depth of 3 feet: Sand[] Silt❑ Clay ❑ Peat❑ Sandy Loam'X Clay Loam ❑ Hardpan ❑ 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.) r NEW INSTALLATION: (No septic tank or seepage pit permitted if pubic sewer is available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK 0� Size.?.9X4 -_1VX-- -,ll.'s Liquid Depth - - - Capacit� ./,ZP-aype^X�J?A;V Materiald0jgCG/� No. Compartments �'_:--_-- Distance to nearest: Well -----------_Foundation -.- .- .- n f , �Q- -- Prop. Line -/�- ------ LEACHINGLINE 4Q No. of Lines„3--------------_.-- Length /of/aacch line/x132...-. 7-,`iNotal Lengtk s��..-..__.-... 'D' Box .v@? Type Filter Materio/O/ Q p ----------- .......... -------------- Distance ... ...Distance to nearest: Well --4?40------------- Foundation ---------------- Property Line ..�Q------------ SEEPAGE PIT r' Depth -_a��-�._ Diameter z'F3h.. Number ------------�_ Rock Pilled Yes $ No P �1 p Water Table Depth --.---4p��-----------------------------Rock Size "'C-.tL�...�....--- r i /�/ pp Distance to nearest: Well _/---_s3S�r _-._------._---_. Foundation .tell/---------_- Prop. Line ....... REPAIR/ADDITION(Prev. Sanitation Permit# .--_.- ------------------------------------ Date .--------.---------_-------------) Septic Tank (Specify Requirements) ,-.,-`---'--- --............... -------------------------------------------------------------------1 Disposal Field (Specify,Requirements)- .----.-.-------------------------------------------- -------------------------------------------------------------------------- ----------------------------- ---- ------ -------- - - ' - -------- -------'.. -----------' -------- '=t---- ------------- ------ --------- . - 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, an�� Rules and Regulations of the San Joaquin Local �fealth District. Home owner or licen- sed agents signature_certifies theallpwing: "-'• - -< "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 ----------------------------/`--�s,�-�-`- - -=- -------------------------_----- Owner B 1✓4'". - Title - i--------- than other than owner) FOR DEPARTMENT USE ONLY Le-------------------------------------------------------------... DATE 47 `�A 61-V------- --- --- --- BUILDING PERMIT ISSUED-..' --------- -----------------------------------------------------------------DATE -- --------------------------------------- ADDITIONAL COMMENTS ..... -- --------------------------- -- --- ------- - ----------------- ------------------- --------_--------------------------- -`---------------------------- --------------- - - ------------------------7,-h------------------------------------------- - ------------------------ ------------------- .-.-- - -- -- - - - ---k----------------- -- 4 --- g Final Inspection by: ------------------------- ^---'-r ------- ^---------------------------------------Date --- -------<-- �' SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M