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FOR.OFNC;E USE: APPLICATION FOR SANITATION PERMIT -----------._- Permit No. ................. (Complete in Triplicate) Date Issued ...................................... This Permit Expires 1 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 ompliance with County Ordinance No. 549 and existing Rules and Regulations: > s JOB ADDRESS/LOCATION ----JV_ r&-' ''"V. CENSUS TRACT ... Owner's Name ........ ......................Phone _. ____S 7Uy ....-- Address ..................... q...- ._ ....TYt ........................ City I ------••--••---••-----------•----------------- Contractor's Name ........ ..----- •-----.License# ..f V-:lam? -- Phone - ------.•_ Installation will serve: e- Residence Apartment House❑ Commercial (]Trailer Court 0 Motel 0 Other------...............................------ Number of living units..... Number of bedrooms .3---.-.Garbage Grinder /r_Q.... Lot Size ..17� --•-•--•--•--•-- Water Supply: Public System and name ---•-------•-•••--•---•-------• •••-------••---•-----••-•------------------•..--•-- --------Private'[` Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay © Peat❑ Sandy Loam 0 Clay Loam ❑ (J�1 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,) PACKAGE TREATMENT [ } SEPTIC TANK- Size-----... ............. Liquid Depth —4-. ............... Capacity Type �"1..- 'K;, - Material._ �7- •f•-•--• No. Compartments _.. .............. Distance to nearest: Well .........2 -�-----------------Foundation ._..l!j.`. � ........ Prop. Line ._ _.._.........___ LEACHINGIUNE [ j No. of Lines ---------3------------ Length of each line....... Total Length ........................... i 'D' Box ............ Type Filter Material ....................Depth Filter Material -----------------------_---................. Distance to,nearest: Wel I —vr.-O.......... Foundation -----/_0..'...---.-..-- ;Property Line ------------------------ (4 SEEPAGE PIT. [ ] Depth -------------------- Diameter ---------------- Number .........-.----------------_ Rock Filled Yes ❑ No C1 Water Table Depth ......Rock Size .....................•--..._---- Distance to nearest: Well ............... .Foundation -------------------- Prop. Line ..... ................ • ' .tea . • t REPAIR/ADDITION(Prev. Sanitation Permit#s--------.---------------------------------- Date ----------------- ----------------- - Septic Tank (Specify Requirements) ................................................................................... .........:.--------•----- --------------- Disposal Field (Specify Requirements) ------••-••--------- . ...---•---------------•-----•-••------•------- ............. .....................{.. -----------•----------..-----•- _.........------------------------ -h..:,: -.... .\-------------------------------------------------------------------------------- ..------------------- {Draw e44iting and required addition on reverse side) I hereby certify that 1 have prepared this application and that the work will be done in accordance with San Joaquin County Ordinances, State Laws,.and Rules and Regulationk 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',s,, /� � ubtect to *rkenan's Compensation'laws of California." Signed .......... L' -t s. ..... y�_- ' Owner By --- ------- _...... cis K-....................................... Title '(I other than owner)'. I - FOR DEPARTMENT-•USE 0)40--- ......... APPLICATION ACCEPTED BY - ................................................ [1 -- a DATE ...._._.:. ....Z-...-Z-. BUILDINGPERMIT ISSUED .................. ....... •.... . ........ ... ..... .. .............DATE ----------------------------------------- - ADDITIONALCOMMENTS--•---•----- .................................. ----------------------------------------•------ ---------------......... ................. ------------................................. -----------••-••-----••---•------•-•--•-•-----------••-•---••--•-----•-•---•--- ............................................ ---------- --------------------------------------------------------------•---------- • -------- -- Final Inspection by. —.— ... -------------Date . �� .. SAN JOAQUIN LOCAL HEALTH TR CT ................. C E. H. 9 1-'68 Rev. 5M