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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT � �1 67 fi (Complete in Triplicate) Permit No. ____.7_____________ ------------ Date Issued .//-— j ............................................. ......... This Permit Expires 1 Year From Date Issued -------_.L Application is hereby made to the San J al Healt istr' fora permit to construct and install the work herein described. This application ' omp ian with C r inance No. 549 and existing Rules and Regulations: 3 7 JOB ADDRESS/LOCATyION ..�n``Z� -._W_b ..Irt. lktAo P�Q�►*t�cc- ( fY/^K'E:ENSUS TRACT -S_ �.__......_... Owner's Name .L..GLrr�..�/ '� ------------ --•..........Phone -------- --------------------- Address . -... �1-• - l�� ....._...__. City ate.---- �- Contractor's Name t�c.�w!__._ �.. ! d:__..License # .11154-)-- Phone _....._._.............._--- Installation will serve: Residence lApartment House❑ Commercial❑Trailer Court ❑ Motel ❑Other --------- ------------ ------------•------- Number of living units:...)------- Number of bedrooms ._-1---._Garbo a Grinder ..._ Lot Size __-----------_....................__________ Water Supply: Public System and name ----------------------•--- ------•-- ---------------------------------------------Private Character of soil to a depth of 3 feet. Sand❑ Silt❑ Clay ❑ Peat❑ Sandy Loam IX Clay Loam ❑ Hardpan ❑ Adobe p 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.) (N NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) V PACKAGE TREATMENT [ ] SEPTIC TANK Size-.S, / --- X__S___ ____________ Liquid Depth __�).-_._ jf� �c -------------- Capacity�.lk�.� .. . . Type(4*- A—____ MaterialNo. Compartments „_ f, Distance to neo st: Well ------------- _______________Foundation -lel-.-'...--...... Prop. Line .... -------- � LEACHING LINE [y No. of Lines --------3............ Length of each line---------- $_..t........ Total Length .......QVIA........... D' Box ............ Type Filter Material ---------S_.R__Depth Filter Material -------- ..-.__--........_........ 01 Distance to nearest: Well ..... D..... Foundation ......10_�......... Property Line .... .............. SEEPAGE PIT [ ) Depth .................... Diameter _._._. ......... Number .__.. - Rock Filled Yes C-] NoC] Water Table Depth ------------------------------------------ -----Rock Size -------------------------------- Distance to nearest: Well ........................................Foundation .................... Prop. Line ....__.._............ REPAIR/ADDITION(Prev. Sanitation Permit# .........................................._. Date ..................................) Septic Wank (Specify Requirements) ..................................................... ............................_-------------------- ---- --------- DisposalField (Specify Requirements) ...................•---•-•----•---...._..---•-----•----•------•-•----•----•----------------........----........._._._._....._..--••-- ------------------------------ ------- ----------- - --------•-------•-.........----................_......••---•-•--•---••---•-------•------------........-•----•----------------------....-------•-- --------- ---------------------------------- -• ------------.--------------------•----------------•----------------------------------------------- ------------------- ................... (Draw existing 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 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 becomesubject to Workman's Compensation laws of California." Signed .....................•-------••-•--------•-----p- ----- -- ---- --- Owner_ , BYC/h�,t fns [.------ Title ---------------------------------------------- (If other than owner) FQR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---je - -------- DATE ./�--x-1.2.---------------- BUILDINGPERMIT ISSUED ---•---- ---•----------------••---------------•-•-•-•-•------------------------------------ ..............DATE ---- --------•---------- ------------------ ADDITIONALCOMMENTS ---------------•----------------------•--•---------------------•--------- ......................................... ------------ - ---------- -------- --------------------------------------------- ........................................................................................ ................................ •------------•---------------------•---• • ............................. ---------- ---------.-------------------------------------•---- •----------•-------•----------- --- Final Inspection by- ---- --- -----------Yl- --- ..._.._ 2 . ..... .... ----•---------------------Dat . . -----------•--........--- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M