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FOR OFFICE USE: ' APPLICATION FOR SANITATION PERMIT r ------------ -------------I------------------- Permit No. (Complete in-Triplicatel --_____------------!f--1 This Permit Expires 1 Year From Date Issued Date Issued Y r 4 Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein desar&d. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION _1 d _ _-�_--U _-__ --_ _ ��jj� -}� ! .- CENSUS TRACT -------- ------ Owner;s Name - , /I// 'c -.A�------G--a�.�------ ------------------------------------------- -------- hone ------------ s s Address �l I " j ------- -- ----- Contractor's Name - =-_ 1_icense # &ZLF,2"Phone ----------------------•------y Installation will serve: Residence [ par' ent House(].Commercial-❑Trailer_Court;E3 — �- ----- - -- t! ; Motel ❑Other --- = ---------------••I i Number of living units:_______ ____ Number of bedrooms -'_ ______Garbage Grinder .___________ Lot Size __ _ __ ___________ _____ — ------ Water Supply: Public System and name ==l `------ ;----•---- #� --------- ----•--- -----------Private Character of soil to a depth of 3 feet: Sand'❑' Silt❑ Cla ❑--'P6c!t-❑�-- Sandy Loam ❑ Clay Loam 0 , Hardpan (] tl Adobe Fill Material ---------::_-- If yes;'type ---------------------------- a '-------------------------- { (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 see t gej,pit permitted`f ublic sewer is available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK [ Size - -- --- - -- f._____ Liquid Depth-- ---- -----•--: Capacity Type Material xe_-____ No. Compartments Y f W Distance to ne est: Well --------------------------------- ----./F---------- Prop. Line ----V= ------ 14 s s LEACHING LINE [ No. of Lines _____ ______________ Length of each line-- ---------------- Total Length .rr2_ZFd______________ 'D' Box __ ___.____ Type Filter Material ---�'� _____Depth Filter Material ___ - . dr � Distancelo nearest: Well ________ Foundation ------/Q_f........ Property Line __ ________________ SEEPAGE PIT [ ] Depth -------------------- Diameter ________________ Number ----------------- ---------- Rock Filled Yes ❑ No ,0 _ x Water-Table.Depth------------------------------------------- ----Rock.Size.-------------------------- Distance to nearest: Well ----------------------------------------Foundation -------------------- Prop. Line .------------_--_----- REPAIR/ADDITION(Prev. Sanitation Permit# ------ ------------------------------------ Date ---------------------------------- Septic ______________-- ___-_________Septic Tank (Specify Requirements) ___._.__.__ _-s,i°__ __ _: ___ =W w. ------ ----------- S1 ---- ---- �_, Sl ^Disposal.: Field (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 its 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 subjectRoorkman's Com nsation laws of California."Signed -------- Owner By --------------------------- -------------------- - L„ (If other than owner) \ FOR DEPARTMENT USE ONLY >,,,. APPLIC -TION ACCEPTED BY ___ _____ ______ _ .� ------------ ----------------------------------------- b� `1 P- - --- - BUILDI PERMIT ISSUED ---------------------------------------------------'--------- - ------------------- ---DATE J----------------------------------- -- ------------- ADDITI I AL COMMENTS .----- ------------------------ ___________________________________ ______ ____ ______ -- ------------_____________ ____________•__•_ h Final Inspection by _ -- -- ------ __ i ------ ----Date --- -- f? ---------------- SAN JOAQUIN LOCAL HEALTH DISTRICT ` i E. H. 9 1-'68 Rev. 5M,