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' I T FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ------- - ----------------------------- r:'I ti �k; � Permit No. _.��-=��----- (Complete in Triplicate) ---------------------------------------- ------------- A --------------------- This Permit Expires 1 Year From Date Issued Date Issued dip (- 2-361 --07 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: X333 C S' INDIA n4 WaLLS COU P, -h . JOB ADDRESSAOCAA�TION ____/4fp1_----A2--------- 1731 '--i1� _ STMT ------.-CENSUS TRACT ---ts"_S-0_.._`. Owner's Name L.Y`A!_ 1Y ------- �` 5i0YY/----------------------------------------------- -------Phone ------------------------------------ Address/i -- /J....14.R-/IV------. r-`--------------AM Cit Contractor's Name _--,_41------Z;`h.C—1------------------------------------------L i c e n s e # , _ P h a n e Installation will serve: Residence R<partment House❑ Commercial ❑Trailer Court 0 Motel ❑Other ---------------------------------------- Number of living units:___1------ Number of bedrooms __3------Garbage Grinder ------------ Lot Size ---/_3P_,k---��------------ \^ Water Supply: Public System and name ---------------------------------------------------------------------------------------------------------------Private ❑ I� Character of soil to a depth of 3 feet: Sand'�ilt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ V) ILI Hardpan ❑ Adobe ❑ Fill Material _A(0_-_ If yes, type ---------------------- (Plot plan, showing size of lot, location of system in,.r6lation to wells, buildings, etc. must be placed on reverse side.) NEW INSTALLATION: (No septic tank or see pa pit permitted if public sewers available within 200 feet,} J! /y PACKAGE TREATMENT [ ] SEPTIC TTANK'[ Size-,6-, le�/`--.x�1vL. Liquid Depth - _______________ Capacity /(!- l?__-_ Type �RjE� �7`Material-GON _ No. Compartments .-___- -.--.,.. Distance to nearest: Well ___ y_ __________________Foundation ----ll.?_-____-____ Prop. Line ____ ........ 6EAGH*4&+0 E [ o, of Lines Length of each line--_-Q-x-4rP_------- Total Length ........ s� Pit-TER BED- 'D' Box -----/----- Type Filter Material _�� __ �� Depth Filter Material ____ .. .............................. t Distance to/nearest: Well ---C=_Y'l/_=------ Foundation ---1� ---------- Property Line --___-�r ._______- SEEPAGE PIT [ ] Depth ____________________ Diameter ---------------- Number ------ Rock Filled Yes ❑ No i❑ Water Table Depth ------------------------------------------------Rock Size -------------------------------- Distance to nearest: Well _______________________________________Foundation -------------------- Prop. Line ___............ REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date ----------------------------------I Septic Tank (Specify Requirements) ----------------------------------------------------------------------------------------------------------- ------ DisposalField (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: "1 certify,that in the performance of the work for which this permit is.issued, 1 shall not employ any person in such manner as to become subject a kman's Compensation laws of California." Signed ------ __ Owner l BY --------=-- - ----- --------=--=---` ------------------------------- Title ------ ----------- - ---------------------- ------- --------------------------------------------------- (If other than owner) FOR DEPARTMENT USE ONLY 7 APPLICATION ACCEPTED BY ------------- -`0_r----------------------------------------------------------------- DATE------- BUILDING -----BUILDING PERMIT ISSUED ------------ ------------------------------DATE -------------------------------- ADDITIONAL COMMENTS ----------- - ----------------- ---------------------------------- --- - ----------- -------I------------- ------------------------------------------------------------------------ - ---- ------------------------- - ---- ----- - - ----------------------------------------------------------------------------------------------------- ---------------- ------- ------ --------------------------- - ------- -------------•---------------------- ---- -- - --- ----- ------- ---- -- ---- ------------ ---------------------------------------------- Final Ins e >' ------ ---- ---- Date --- ----------------------------------- F '`� SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M [��