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4 FOR OFFICE USE- APPLICATION FOR SANITATION PERMIT --- ----------------------------- 7JC- - - (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 existing Rules and Regulations: JOB ADDRESS/LOCATION . S-0�------- 5�-`---- WA4�vo 7--------- ---- --- ------ ----------CENSUS TRACT -•- Owner's Name -----------1%-A------- y 5----------------------------------------------------------------------------Phone 'ter- c�_' `�------ ,!D 6 S� W14 Zlyv� Cit `��` q� Address ------------- --------------- ------ ------------------------------------- ----------- ----------- Y ------------- Contractor's Name ------ - S© License #4 �------- Phone ✓� 3"y�f �l -------------- Installation will serve: Residence ®Apartment House❑ Commercial ❑Trailer Court Motel ❑Other ------------------ ------------------------- sd x tee Number of living units-----/___ Number of bedrooms -A______Garbage Grinder -*A----- Lot Size ______________________©___________________-- Water Supply: Public System and name ----- ntY-------------•----------------------------------------- ---------------------------------Private ❑ Character of soil to a depth of 3 feet: Sand'® Silt❑ Clay ❑ Peat❑ Sandy Loam 0 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.) NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) BIN PACKAGE TREATMENT [ ) SEPTIC TANK'f ] p Siie------------------------------------------------ Liquid Depth ---_------------------_- CapacitY -------------------- Type -------------------- Material------ --------------- No. Compartments ------ --------------- Distance •to nearest: Well ------------------------------------Foundation ---------------------- Prop. Line -----------------_ _ LEACHING LINE [ ] No. of Lines ________________________ Length of each line---------------------------- Total Length ____________________-_-- 'D' Box -----------. Type Filter Material --------------------Depth Filter Material -------------------------------------------- Distance to nearest: Well ------------------------ Foundation ------------------------ Property Line ---------------.__-_____ SEEPAGE PIT [ ] Depth ___________________ Diameter _______________ Number ---------------------------- Rock Filled Yes ❑ No C] WaterTable Depth ------- ----------------------------------------Rock Size -------------------------------- Distance to nearest: Well ----------------------------------------Foundation -------------------- Prop. Line -----_-------------- REPAIR/ADDITION(Prev. Sanitation Permit# -------•------------------------------------ Date ----------------------------------1 Septic Tank (Specify Requirements) ------------------T'.2aQ -+F41!---------5_!T- p__7 -r------ TAIv--1---------_--_---------------- ----------- S� ' e ey� 3--I�r . , Disposal Field (Specify Requirements) -------� -- - ----------- - ---- ° �------ � --�----------------- ---------- ) Te`'' p ` . f �'� ` F (Draw existing and required addition on reverse side) , 1 hereby certify that I have prepared this application and that the work will be clone in accordance with San Joaquin T 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 ----------------------------------------------- -title ------Cf- eY_7rAc rO T--------------------------- ------- (If other than o her) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ---�t --�------------------------------------------------------------------------ DATE ----- BUILDING --BUILDING PERMIT ISSUED ---------------------------------------------------------------- -------DATE -------- -------------- ----.:i------------- ADDITIONALCOMMENTS --- ---------- --- --------------------- ---- -------------------------- -- ------------------------ ------------- ----- -- ---- -------------------- - ------- - --- --- ------------------------------------------------------------------------------------ ---------- - ---------------------------------------------------------------------------- - -- ----- -- ----------- - -------------------- ---------------------- i -------- _ f --- Final Inspectiony�� --- - - -- - ------ --- - ---------- -------Date -�- O`�� I SAN JOAQUIN LOCAL HEALTH DISTRICT / E. H. 9. 1-'68 Rev. 5M