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V.-FOR OFFICE USE: ;�� 1, APPLICATION FOR SANITATION PERMIT - - -------------- - IPermit No,. (Complete in Triplicate) Permit ---------------- -------------------------------------------_--------__.__ _ This Permit Expires ] Year From Date Issued Date Issued I � 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 .____- :_ __ �, ± --------------------CENSUSTRACT -------------------------- Owner`s Name �LL�' ---- -±---G z1V_L� -----`---:--------------- ------Phone 4(P---- 30/4- i Address --------------- ---- -- / d t------------------------------ - - - --------------- -- ------------ city ---��"1�----�'/_'if'-------- ----------------••-•--------- � Contractor's Name. - __-_ A_ - - - ____ ---- - / ----- - - -+---.License # _I�D�C- ----- Phone4_��_f_&i9_7...___ Installation will serve: Residence%,Apartment House,❑ Commercial:❑Trailer Court i❑ + 'Motel ❑Other = _ r- Number of living units: 0-- Number of bedro s _._Garb ge-Grinder.__/ _ Lot Size ---- Water Supply: Public System and name ______ i l � ._�/. --------------------- ---------Private ❑ Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Gay ❑ Peat❑ Sandy Loam ❑ Clay Loam F1 j Hardpan ❑ Adobe Fill Material ------------ If yes, type ---------_______________ ---- (Plot plan, showing size of lot, locationiof system fin relation to ells,- buildings; etc. must be•,placed on reverse side.) NEW INSTALLATION: (No septic tank or seepage p t permitted if public sewer is available within 200 feet,) U� PACKAGE TREATMENT [ I SEPTIC TANK [ ] i Size-----------------•------------------- ---- -•-- Liquid Depth -------------------------- Capacity -------------- -- Typ --------- mpartments----------- Material--------.------------- No. CoE�� Distance to nearest: Well ------------------- ---------- -----Foundation --------,_______----- Prop. Line _____________---.--- LEACHING LINE [ j No. of Lines ___________ _ _ 3 °s Length of-each line---------------------- Total'Length ------ ----_- -----. - D' Box --- --- Type Filter Mat pial _____-_______Depth Filter Material Distance to nearest: Well ..---------------------- Foundation ------- ------------- -- Property Line ---------._____ SEEPAGE PIT ( '` # ` [ I 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# ____�__.-__ r-_-.a Date ---------------------------! Septic Tank (Specify Requirements] -----------------------------------------"------ ( i 1+ ---------- ----------------------•----- # Risposal Field (Specify Re uirements) ------ __ __t� __- _ ------_-___ r�_-.f i- f [� f- -------AND ----- ) ---------------------------------------------------------------------------- (Draw existing and required addition on reverse side) l 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: �— 4 "! certify that in the performance of the work for which this permit is issued, I shall not employ any person in such manner fi as to b ubject to Workman's:C mpensationyla�ws of California." t Signed - - ��Tt r�*� Own ------- t BY -------- `�1 - ` Title _P e _ _ ; A; (if other than owner) ______ k FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ____ - ----___ DATE -�p � --- BUILDING PERMIT ISSUED - --------------------- ------ - --------- - - --------DATE ----------•--•----- ADDITIONAL COMMENTS --------------f = 4 -------------------------------- - ________________________________ 1- _ ------------ ` - ' -2 -�-- --- -------------------------- ------------_---------------------------------------------------- = = ' Final Ins action b �- ---- ----------------- -- - - - - - - t --------- "- - - -- ------ �� - -- ---- -- - --------- ---- - -- - - - A y: - - - ------- - - --------- - ---- - Da e SA JOAQUI ' LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M ' r