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�c FOR OFFICE USE- APPLICATION FOR SANITATION PERMIT .� _ --------------- ---- - Permit No: (Complete in Triplicate) --- ---- --------- --------------------------- - __� ---_--_-_---------,.--_- -------- This Permit Expires 1 Year From pate 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 ._ __ �-. fir---- _r _t^ ✓---, A-T-^::�--.----CENSUS TRACT -------------------------- J ----Phone -`�/Z-4/---1---- Owner's Name - - t�---�------/---�- ��-�� - ---------------------------------- /- Address ------- C �� i---- C.�'-'a Y--zev------------------------------ city Cf ,l "-C --------------------------------------------------- - l� , Contractor's NameLicense # - Phone . ,-------- ---- --- Installation will serve} Residence 2-;�partment House❑ Commercial ❑Trailer Court ;❑ Motel ❑Other -------------------------------------------- Number of living units:---- Number.•'of bedrooms - -------Garbage Grinder Lot Size --------- Water Supply: Public System and name __-_ 41-- l - ------------------------------------------------==----------------- ------Private ]D 'Character of soil to a depth of 3 feet: Sand'Er, ilt❑ Clay ❑ Peat ❑ Sandy Loam .E] Clay Loam.❑ . .> r Hardpan ❑ Adobe'❑ Fill Material ------------ If yes, type ---------------------------- (Plot plan,.showing ---------------------------(Plot.plan,.showing size of lot, location of system in relation to wells, buildings,Metc._must_be .placed on reverse side.) NEW INSTALLATION: (No septic tank or,aeepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ ] ! SEPTIC TANK:[► Size___-1,, ------------- Liquid Depth ___-�f- ______.,.____ ► Capacity 40�, � 2------- Type -------------------- Material_, No. Compartments -_-- -w___•.---• stance to nearest: Well ___fr¢p <'f_'-----------------Foundation ----------- Prop, tine _____�_ _~ --------- LEACHING LINE --_____LEACHING-LINE [ No. of _Lines --------------- Length of each line----�'�7_ ------------- Total length -----1.'-a...a--_-......... D' Box _ Type Filter Material d9l' Depth Filter Material --------- _________ - 'Distdnic -to-nearest: Well--4:�L =---Foundation :.= -Y- ---- - ---Pro a Line. SEEPAGE PIT [ ] Depth------------------- Diameter ---------------- Number --------------------------- Rock Filled Yes '❑ No (3 R WaterTable Depth ------------------------------------------------Rock Size -------------------------------- Distance to nearest: Well ----------------------------------------Foundation -------------------- Prop. Line ----------- ........ _ r REPAIR/ADDITION(Prev. Sanitation Permit# ______._-_____---------------------------- Date _______________-________-____..__) f Septic Tank [Specify Requirements] ------=------------ -------------:---------------------------------------------- DisposalField (Specify ..Requirements)----------------------------------- ---------------------------------------------------------------------------------------------------- l ---------- ---------------- --------------------------------------- (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 Work s, pe sati.on laws of California." t Signed -- ------- ------ ` --------- Owner BY -------------------------------=------------------------------------------------------------------------- litle --- - --------- ----- ----------------------------------------- (If other than owner) FPR .DEPARTMENT USE ONLY APPLICATION ACCEPTED BY .__,- -�--- - -- . DATE __-- -""--�-7----�,:__.____-•--- ----- ---------------------------- ---------------------------- --- -----____- BUILDING PERMIT ISSUED - ---------- _ = _ - - = =-------=--- DATE -------------•----------------------------- ADDITIONAL COMMENTS ---1i---=- ' �' " �-�, _�Hr4 ��,_-_ __.= E.�� __ -�� z _-------------------------------------------------- ------------------------------------------------------------- --------------------------- ---------------------- ------------------------ ��-�' ` - r 5- - = � �__r�w ---------------------------- - ------------------- - ------ -- _�_ _---q- Final Inspection by: ------- = '57 ,---------------------'- Date . . �-�,�- - _-------- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M,