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rVK UMLL Ubt:: APPLICATION FOR SANITATION PERMIT �- -- ------ Permit No. - � . Qs ----- --------�-- ----- (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 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/LOCA N ._sJ��y_ -h14t1s� / o' lT' rt'.- .--.--_-._CENSUS TRACT --------------------__.. yt // C Owner's Name UOO U-1[2��-- - ------------------ ;;ii - ------------Phone A _y---- Address - --- - .-_7 '5.7 37------ -~ - --- City / ----------------- - - Contractor's Name .- 5 017Z,�--------------------------___---------------- ---------.License# -------------- _------ Phone ------ ------ ......... Installation will serve: Residence ❑Apartment House C❑ Commercial ❑Trailer Court 0 Motel ER-Other r-vo -Y,4W /j Number of living units------------- Number of bedrooms ------------Garbage Grinder __.------.__ Lot Size ....r�.�Y----__________- Water Supply: Public System and name .--------------------------------_------------------------- --------- -------------------------------------Private LH_ r, Character of soil to a depth of 3 feet: Sand 0 Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam 0 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.) NEW INSTALLATION: (No septic tank or seeps Pit permitted if public sewer is available within 200 feet,) v PACKAGE TREATMENT [ ] SEPTIC TANK[ /� Size_j.C?,YSC.".C-y-----_-___ Liquid Depth __ --.._._..._. 7, Capacity -, 0,0---.-- Typel§"_ 5_✓ ecce Material 6,z -_e, ej_. No. Compartments -__-- ._..___..._. / istance to nearest: Well ---'? ...4527d-----Foundation __ _f a_------------ Prop.Prop. Line ....6_.:..:........ LEACHING LINE [✓ '_�No. of Lines -----/------ -------_ Length of each line........ Total Length .-_---.. /n� 'D' Box,tYD___ Type Filler Material �-X�4Depth Filler Material -----157J. Distance to nearest: Well -�EiZ'?_�____---_ Foundation _!� -__---_--- Property Line __SS�r___.......- 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— ------------- ------I \�^ Septic Tank (Specify Requirements) ------------- it�kx�ws. ....i?fC.te- .--- �lP----- --------------- ----.----- L Disposal Field (Specify Requirements) ---- -- .... _.------ --------- ------- - ------------------------ --- - - ------ - ------- ------------- ------- -------- --._._... (Draw existing and required addition on reverse side) I hereby certify that I have prepared this application and thal 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 ct to orkman's Co sation laws of California." Signed,(,... -. Owner By -- ---- --------------------------I-------------------- -----------------------. Title ----------------------- - ----------------- (If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY -------- - - r_ i - ----------------------- DATE---- .=- BUILDING PERMIT ISSUED - -W - -- -----------------------------DATE - -------------------- ----- A DITIONAL COMMENTS2 - - - - dUt <t+�r- c - - - --- ------ - --,----[----,,F,,- - �-------- - •---Ei - - --------- t� ----------------- -- -------- -- - -- - - --- - ------------ ------------------- ------------- Final Inspectionby - ---- - - - - ----------------------- --------------------------Date ----- --- --� �- -------- -- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M