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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ti: , -...... ..... .....-- - ---- ...---.. .... Permit No. .7t.g.Y.v.... 'Complete in Triplicate) -- --- ---------------- Date Issued 1--.1"........ This Permit Expires i 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 application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: 0 JOB ADDRESS/LOCATIO 6-l.a� -�^'-- - f-""'""'r -� CENSUS TRACT ......... ._............. Owner's Name ..... , ................ ............ .. . Phone Y 3-03� �. ..3 ... 6�(•!/ �....... ....... City -------------- _- --- A ress ��1� %4.7,Y_41. 6_ Go7 Contractor's Name ...... License #�_..._ Phone Installation will serve: Residence ❑ Apartment House Commercial (]Trailer Court ❑ Motel ❑Other ------ . ........ ...... 1/ Number of living units: _....... Number of bedrooms ___._-.. ..Garbage Grinder ......___... lot Size .!1-1 . .'�'Q. - --- Water Supply: Public System and name --- --------------_------- ....---.....__-------------- --------.Private I Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat El Sandy Loam El Clay loam [❑ � Hardpan E] Adobe EJ 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,) PACKAGE TREATMENT [ ] SEPTIC TANK p Size ......... Liquid Depth ............. ............• Capacity2gCVG,*+Type __ Material. CST-t&t4l�,ilo. Compartments .. .......... n s r Distance to nearest: Well ._.... 0�_. ... .....Foundation .__.�_© :'f". ... Prop. Line ..._�_:�":...... r � LEACHING LINE [ ] No. of Lines --.-__.rL._...--_ Length ofpeach hne. .. __._.._.._. Total length ._ r00.............. lDQ)atw,q-C, 'D' Box __._Type Filter Material h e-k.....Depth Filter Material ............................. 13 ar LC,' X $O Distance to nearest: Well ._.__:t..... .. Foundation .._i0�f... ---- Property Line S�f............. SEEPAGE PIT [ ] Depth Diameter . Number ............. Rock Filled Yes No d 1 ' / Water Table Depth -----------• -----------•----------- --------Rock Size ........ ...................... _ 6 x � xio - PJ?JJ1A.1 Std W VO Distance to nearest: Well ----------/ .._. _________Foundation !0 +-- Prop. Line ...... REPAIR/ADDITION(Prev. Sanitation Permit # ................................ ..... Date ..................................) Septic Tank (Specify Requirements) ......••... ......................... .. . ..............................................................._............................ 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 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 subject to Workman's Compensation laws of California." Signed . ------...... .... .. .. .................. ---------- -- ------•--..._ Owner ��,� BY I . ---- `-'�� y.. . ........... .. . _....._....... ........ ............ •.. ._....... .. .... .. . ..........__ Title ..... (If r than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------- ... _------------- .------•---•-----------------. DATE ...5�.- .- %._......... ) BUILDING PERMIT ISSUED ............................ •-• -••------.......... DATE .. ADDITIONAL COMMENT ...-.;,... x,.f` y. ✓yt�� _0�� 1f/Ya__(/f`F.w..G+sR :r��sitr L-fZ •!G2 z.�sad.... . ~ ---....... ..------------------.__..•...................................... .................. .------------------------------------------------ ............................................. ..----.....-------------•----------------_..._.-............................................. FinalInspection by: ................................. -------- _ -------Date .--•---. ---...-------•--------..-.-- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'66 Rev. 5M